Andrea Johnson, L. Stock, Jane C. Brennan, Justin J. Turcotte, Benjamin M. Petre
Introduction: Hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) has been demonstrated to improve outcomes but carries inherent risks of complications and the need for revision arthroscopy or conversion to total hip arthroplasty (THA). The objective of this study is to evaluate preoperative radiographs, patient outcomes, and risk factors for reoperation in patients undergoing HA for FAIS. Methods: A retrospective review of 351 consecutive patients undergoing HA for FAIS from July 2015 to June 2018 was conducted. The primary endpoints were revision hip arthroscopy (RHA) and THA. Univariate and multivariate analysis was performed to evaluate the risk factors for these endpoints. Results: By the end of the study period, 21 (6.0%) patients had undergone an RHA and 27 (7.7%) patients had undergone a THA. When comparing patients who had an RHA to those that did not, there were significant differences in preoperative radiographic characteristics, including smaller sourcil angle (P = 0.012) and lower Tönnis grade (P = 0.038) between groups. These patients were also more likely to have had a postoperative injection in the 1st year (P < 0.001). No factor was independently predictive of revision HA in multivariate analysis. Patients who underwent a subsequent THA were significantly older (P < 0.001) and required more suture anchors for repair (P < 0.001) than those that did not. On preoperative radiographs, Tönnis grade (P = 0.43) skewed higher. The multivariate regression models generated area under the curve of 0.740 and 0.864 for RHA and THA, respectively, indicating acceptable to strong predictive performance. Conclusion: Individual preoperative patient characteristics and radiographic findings are of limited value in assessing risk for RHA or THA after HA for FAIS. However, predictive models incorporating demographic and radiographic findings hold promise for identifying patients at risk for these outcomes. Further study is needed to refine models and assess their value in preoperative patient selection and counseling.
{"title":"Hip arthroscopy for femoroacetabular impingement syndrome: preoperative radiographic findings and risk factors for reoperation at 3–6 years postoperatively","authors":"Andrea Johnson, L. Stock, Jane C. Brennan, Justin J. Turcotte, Benjamin M. Petre","doi":"10.4103/jotr.jotr_64_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_64_22","url":null,"abstract":"Introduction: Hip arthroscopy (HA) for femoroacetabular impingement syndrome (FAIS) has been demonstrated to improve outcomes but carries inherent risks of complications and the need for revision arthroscopy or conversion to total hip arthroplasty (THA). The objective of this study is to evaluate preoperative radiographs, patient outcomes, and risk factors for reoperation in patients undergoing HA for FAIS. Methods: A retrospective review of 351 consecutive patients undergoing HA for FAIS from July 2015 to June 2018 was conducted. The primary endpoints were revision hip arthroscopy (RHA) and THA. Univariate and multivariate analysis was performed to evaluate the risk factors for these endpoints. Results: By the end of the study period, 21 (6.0%) patients had undergone an RHA and 27 (7.7%) patients had undergone a THA. When comparing patients who had an RHA to those that did not, there were significant differences in preoperative radiographic characteristics, including smaller sourcil angle (P = 0.012) and lower Tönnis grade (P = 0.038) between groups. These patients were also more likely to have had a postoperative injection in the 1st year (P < 0.001). No factor was independently predictive of revision HA in multivariate analysis. Patients who underwent a subsequent THA were significantly older (P < 0.001) and required more suture anchors for repair (P < 0.001) than those that did not. On preoperative radiographs, Tönnis grade (P = 0.43) skewed higher. The multivariate regression models generated area under the curve of 0.740 and 0.864 for RHA and THA, respectively, indicating acceptable to strong predictive performance. Conclusion: Individual preoperative patient characteristics and radiographic findings are of limited value in assessing risk for RHA or THA after HA for FAIS. However, predictive models incorporating demographic and radiographic findings hold promise for identifying patients at risk for these outcomes. Further study is needed to refine models and assess their value in preoperative patient selection and counseling.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"62 1","pages":"22 - 27"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86024890","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}
Navin Shukla, Lata Keshkar, J. Mukherjee, Ratnesh Kumar, Shivendra P Singh, A. Agrawal
Background: Bipolar hemiarthroplasty (BHA) is commonly used to treat fracture neck of femur (NOF) in the elderly, despite the fact that the appropriate treatment of fracture NOF is still controversial. In this prospective study, the functional outcomes of NOF fracture after surgery in the elderly, who underwent BHA with a fully coated hydroxyapatite stem with a collar (CORAIL Stem). Materials and Methods: Forty-three consecutive elderly patients with NOF fracture underwent BHA through the lateral Hardinge approach. They were followed up after surgery for 1 year. Two patients expired and one was lost to follow-up and were not included in the study. Postoperative follow-up was done every 4–20 weeks and thereafter at intervals of 3–12 months. Harris hip score (HHS) was recorded at each follow-up visit and complications were noted. Results: Forty patients with a mean age of 77 (62–93) years were followed up after surgery for 1 year. Two patients (4.7%) expired and one (2.3%) was lost to follow-up and were not included in the study. HHS of our cohort of patients averaged 86 (72–99), which falls in the category of a good outcome (80–90). A mild negative correlation (correlation index − 0.2) of age and HHS was observed but was not significant (P = 0.56). Significantly more female patients suffered from NOF fracture (male - 13 [32.5%]: female - 27 [67.5%]; P = 0.03). The left side was injured more often than the right (left 23 [57.5%], right 17 [42.5%]; P = 0.34). Thirty-three patients (83.5%) had one or more comorbid conditions. The mean HHS of female and male patients was 86.41 and 85.39, respectively. This difference was not significant (P = 0.33). There was no difference in outcome, whether an injury occurred to the dominant or nondominant extremity. Complications occurred in seven (17.5%) patients. Conclusions: In the first follow-up year, a good functional outcome with a low complication (17.5%) and mortality rate (4.7%) was observed. Twenty-seven patients (62%) were absolutely pain-free. There were no dislocations, revisions, or additional surgeries in any patients. Most patients returned to their preinjury activity level. To conclude, the procedure is safe and rewarding in the elderly.
{"title":"Functional outcome (Short Term) of modular cementless bipolar hemiarthroplasty (Hydroxyapatite-Coated Stem) for fracture neck of femur in the elderly","authors":"Navin Shukla, Lata Keshkar, J. Mukherjee, Ratnesh Kumar, Shivendra P Singh, A. Agrawal","doi":"10.4103/jotr.jotr_5_23","DOIUrl":"https://doi.org/10.4103/jotr.jotr_5_23","url":null,"abstract":"Background: Bipolar hemiarthroplasty (BHA) is commonly used to treat fracture neck of femur (NOF) in the elderly, despite the fact that the appropriate treatment of fracture NOF is still controversial. In this prospective study, the functional outcomes of NOF fracture after surgery in the elderly, who underwent BHA with a fully coated hydroxyapatite stem with a collar (CORAIL Stem). Materials and Methods: Forty-three consecutive elderly patients with NOF fracture underwent BHA through the lateral Hardinge approach. They were followed up after surgery for 1 year. Two patients expired and one was lost to follow-up and were not included in the study. Postoperative follow-up was done every 4–20 weeks and thereafter at intervals of 3–12 months. Harris hip score (HHS) was recorded at each follow-up visit and complications were noted. Results: Forty patients with a mean age of 77 (62–93) years were followed up after surgery for 1 year. Two patients (4.7%) expired and one (2.3%) was lost to follow-up and were not included in the study. HHS of our cohort of patients averaged 86 (72–99), which falls in the category of a good outcome (80–90). A mild negative correlation (correlation index − 0.2) of age and HHS was observed but was not significant (P = 0.56). Significantly more female patients suffered from NOF fracture (male - 13 [32.5%]: female - 27 [67.5%]; P = 0.03). The left side was injured more often than the right (left 23 [57.5%], right 17 [42.5%]; P = 0.34). Thirty-three patients (83.5%) had one or more comorbid conditions. The mean HHS of female and male patients was 86.41 and 85.39, respectively. This difference was not significant (P = 0.33). There was no difference in outcome, whether an injury occurred to the dominant or nondominant extremity. Complications occurred in seven (17.5%) patients. Conclusions: In the first follow-up year, a good functional outcome with a low complication (17.5%) and mortality rate (4.7%) was observed. Twenty-seven patients (62%) were absolutely pain-free. There were no dislocations, revisions, or additional surgeries in any patients. Most patients returned to their preinjury activity level. To conclude, the procedure is safe and rewarding in the elderly.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"32 1","pages":"28 - 32"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77831659","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 : 2023-01-01DOI: 10.4103/jotr.jotr_125_22
A. Agrawal, M. Ojha, Somok Banerjee
Giant cell tumor (GCT) is a common, mostly benign, locally aggressive tumor of bone. Distal femur, proximal tibia, and distal radius appear to be the most affected parts of the skeleton. We are reporting a case of recurrent GCT involving the distal tibia treated with resection and arthrodesis of the ankle using contralateral fibular strut graft. A male patient presented to us with pathological fracture of the left distal tibia due to recurrent GCT. Radiological assessment was suggestive of locally aggressive tumor involving the meta-epiphyseal region. The patient underwent wide margin excision of tumor and ankle fusion using the contralateral fibula as a second pillar to increase the stability of construct. GCT involving the distal tibia is a rare presentation and demands meticulous efforts to manage after recurrence. Resection of tumor mass and ankle arthrodesis is a good option as it provides a stable ankle and overall good patient satisfaction.
{"title":"Tumor resection, reconstruction, and ankle fusion for recurrent giant cell tumor of the distal tibia","authors":"A. Agrawal, M. Ojha, Somok Banerjee","doi":"10.4103/jotr.jotr_125_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_125_22","url":null,"abstract":"Giant cell tumor (GCT) is a common, mostly benign, locally aggressive tumor of bone. Distal femur, proximal tibia, and distal radius appear to be the most affected parts of the skeleton. We are reporting a case of recurrent GCT involving the distal tibia treated with resection and arthrodesis of the ankle using contralateral fibular strut graft. A male patient presented to us with pathological fracture of the left distal tibia due to recurrent GCT. Radiological assessment was suggestive of locally aggressive tumor involving the meta-epiphyseal region. The patient underwent wide margin excision of tumor and ankle fusion using the contralateral fibula as a second pillar to increase the stability of construct. GCT involving the distal tibia is a rare presentation and demands meticulous efforts to manage after recurrence. Resection of tumor mass and ankle arthrodesis is a good option as it provides a stable ankle and overall good patient satisfaction.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"67 1","pages":"112 - 115"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79098245","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}
Asif Hussain, Sushila Saini, Jeetesh V. Patel, C. Pal, Hemant Chahar, R. Yadav
Context: Osteoporosis remains a significant public health problem in many parts of the world, including India. The efficacy of oral bisphosphonates is lower because of poor compliance. Annual treatment with zoledronic acid has been reported to improve outcomes. Objective: To study the benefits and side effects of zoledronic acid in patients with osteoporosis. Methods: This is a blinded randomized clinical trial conducted at a government hospital. Patients aged 50–89 years with bone mineral density (BMD) T score < −2.5 or < −1.5 with 2 mild vertebral fractures or 1 moderate vertebral fractures were randomized to receive placebo versus zoledronic acid. A total of 200 patients were be studied, 100 in each arm. Zoledronic acid was given in single dose (15-min infusion). Serum calcium, dual-energy X-ray absorptiometry, and lateral spine radiographs were performed at enrollment and after 12 months. The primary endpoint was combined risk of new-onset vertebral and hip fractures. The secondary endpoints were new-onset vertebral and hip fractures and BMD. Results: The primary outcome was reduced by 79% during the 1-year period in zoledronic acid, compared to placebo (3% in the treatment group vs. 14% in the placebo group; relative risk (RR): 0.21; 95% confidence interval [CI]: 0.06–0.72, P = 0.01). Treatment with zoledronic acid reduced the risk of new-onset vertebral fracture by 82% (RR: 0.18; 95% CI: 0.04 to 0.79; P = 0.02). No significant differences in new-onset hip fractures were noted (RR: 0.33; 95% CI: 0.03–3.15; P = 0.33). A significant increase in BMD score was found after treatment with zoledronic acid compared to placebo group (P < 0.05). No serious adverse events were noted. Conclusion: Annual infusion of zoledronic acid reduces the risk of combined fracture of vertebra and hip and improves the bone mineral density in osteoporotic patients.
{"title":"Annual zoledronic acid for the treatment of osteoporosis: A randomized controlled trial","authors":"Asif Hussain, Sushila Saini, Jeetesh V. Patel, C. Pal, Hemant Chahar, R. Yadav","doi":"10.4103/jotr.jotr_58_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_58_22","url":null,"abstract":"Context: Osteoporosis remains a significant public health problem in many parts of the world, including India. The efficacy of oral bisphosphonates is lower because of poor compliance. Annual treatment with zoledronic acid has been reported to improve outcomes. Objective: To study the benefits and side effects of zoledronic acid in patients with osteoporosis. Methods: This is a blinded randomized clinical trial conducted at a government hospital. Patients aged 50–89 years with bone mineral density (BMD) T score < −2.5 or < −1.5 with 2 mild vertebral fractures or 1 moderate vertebral fractures were randomized to receive placebo versus zoledronic acid. A total of 200 patients were be studied, 100 in each arm. Zoledronic acid was given in single dose (15-min infusion). Serum calcium, dual-energy X-ray absorptiometry, and lateral spine radiographs were performed at enrollment and after 12 months. The primary endpoint was combined risk of new-onset vertebral and hip fractures. The secondary endpoints were new-onset vertebral and hip fractures and BMD. Results: The primary outcome was reduced by 79% during the 1-year period in zoledronic acid, compared to placebo (3% in the treatment group vs. 14% in the placebo group; relative risk (RR): 0.21; 95% confidence interval [CI]: 0.06–0.72, P = 0.01). Treatment with zoledronic acid reduced the risk of new-onset vertebral fracture by 82% (RR: 0.18; 95% CI: 0.04 to 0.79; P = 0.02). No significant differences in new-onset hip fractures were noted (RR: 0.33; 95% CI: 0.03–3.15; P = 0.33). A significant increase in BMD score was found after treatment with zoledronic acid compared to placebo group (P < 0.05). No serious adverse events were noted. Conclusion: Annual infusion of zoledronic acid reduces the risk of combined fracture of vertebra and hip and improves the bone mineral density in osteoporotic patients.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"45 1","pages":"40 - 43"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83647070","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 : 2023-01-01DOI: 10.4103/jotr.jotr_131_22
Umesh Jain, Amol Gowaikar, P. Patil, U. Ghate, Rishabh Nair
Objective: To determine clinical and patient satisfaction outcomes after posterior cervical foraminotomy (PCF), for the patients suffering from cervical monoradiculopathy, in the absence of myelopathy. To assess the efficacy of PCF. Methods: This was a prospective and multicentric study including patients of cervical monoradiculopathy, who underwent PCF surgery in the “department of orthopedics,” between October 2020 and November 2022. The hospital records, images, operation notes, and follow-up records were reviewed and analyzed. Thirty patients of cervical monoradiculopathy were investigated. All the patients who have satisfying inclusion criteria in the study period from October 2020 to November 2022 were included in the study. Patients of any age group and both the sexes and who were operated for PCF were considered. Those patients were then meticulously subjected to thorough inspection, with the help of hospital records, images, and operation notes and interviews. All the details of the patients were obtained based on previous hospital records and interactions with them and through neck disability index (NDI) score. Discussion: Decompression of the nerve root can be done by either anterior or posterior approach. Anterior approach carries risk of damaging oesophagus, trachea, carotid sheath and recurrent laryngeal nerve posterior approach includes foraminotomy in form of drilling some part of facet joint and adjacent lamina, disc can also be removed in selected cases this approach do not carry much risk. Many comparative studies shows equal beneficial outcome of pcf (posterior cervical foraminotomy)as compared to acdf (anterior cervical disectomy with fusion). Results: When we analyzed the NDI scores at different intervals there has been a positive trend showing the improvement in overall well being of an individual patient and this has resulted in major porting of the patients that has been taken as a sample has returned to there normal day to day living which they used to have earlier, before suffering from cervical radiculopathy. Conclusion: The final conclusion that can be drawn after analyzing the NDI score at different interval of time i-e before surgery, immediately and after surgery, 6 weeks post surgery, 3 months post surgery and 6 months post surgey is that patients have shown successive improvements with every follow up done.
{"title":"Prospective study of posterior cervical foraminotomy for cervical radiculopathy in absenceof myelopathy","authors":"Umesh Jain, Amol Gowaikar, P. Patil, U. Ghate, Rishabh Nair","doi":"10.4103/jotr.jotr_131_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_131_22","url":null,"abstract":"Objective: To determine clinical and patient satisfaction outcomes after posterior cervical foraminotomy (PCF), for the patients suffering from cervical monoradiculopathy, in the absence of myelopathy. To assess the efficacy of PCF. Methods: This was a prospective and multicentric study including patients of cervical monoradiculopathy, who underwent PCF surgery in the “department of orthopedics,” between October 2020 and November 2022. The hospital records, images, operation notes, and follow-up records were reviewed and analyzed. Thirty patients of cervical monoradiculopathy were investigated. All the patients who have satisfying inclusion criteria in the study period from October 2020 to November 2022 were included in the study. Patients of any age group and both the sexes and who were operated for PCF were considered. Those patients were then meticulously subjected to thorough inspection, with the help of hospital records, images, and operation notes and interviews. All the details of the patients were obtained based on previous hospital records and interactions with them and through neck disability index (NDI) score. Discussion: Decompression of the nerve root can be done by either anterior or posterior approach. Anterior approach carries risk of damaging oesophagus, trachea, carotid sheath and recurrent laryngeal nerve posterior approach includes foraminotomy in form of drilling some part of facet joint and adjacent lamina, disc can also be removed in selected cases this approach do not carry much risk. Many comparative studies shows equal beneficial outcome of pcf (posterior cervical foraminotomy)as compared to acdf (anterior cervical disectomy with fusion). Results: When we analyzed the NDI scores at different intervals there has been a positive trend showing the improvement in overall well being of an individual patient and this has resulted in major porting of the patients that has been taken as a sample has returned to there normal day to day living which they used to have earlier, before suffering from cervical radiculopathy. Conclusion: The final conclusion that can be drawn after analyzing the NDI score at different interval of time i-e before surgery, immediately and after surgery, 6 weeks post surgery, 3 months post surgery and 6 months post surgey is that patients have shown successive improvements with every follow up done.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"53 1","pages":"82 - 87"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88812276","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: The Primary objective of this prospective study is to study the rate of infection, number of days required for formation of healthy granulation tissue, healing of soft tissue injury and number of days of hospital stay and cost effectiveness associated with soft tissue injury treated by Vacuum Assisted closure therapy. Methods: This is a prospective observational study of 30 patients presenting with open musculoskeletal injuries in extremities that required coverage procedures in the department of Orthopaedics, Sri Aurobindo Medical College and PG Institute, Indore. All these patients had undergone wound debridement and fracture fixation. This was followed by application of Vacuum Assisted Closure (VAC). The infection rate analysed by clinical findings and investigations. Assessment of these wound(s) were done on a regular basis by wound bed score. Assessment of rate of granulation was done on every 3rd day. Based on the rate of granulation, definitive surgical intervention (skin grafting, secondary closures and flap cover procedures) was done. The patient was sent home after performing the definitive surgical intervention. Results: The infection rate was low when compared to literature study of conventional dressings. The primary wound coverage can be done earlier wound healing was also faster in patients. Conclusion: This is a simple and low cost method for treating soft tissue injury associated with severe open fractures. It can be done even in peripheral hospitals with low resources. The rate of granulation tissue formation is good with vacuum assisted closure. Also compliance of patient is good in vacuum assisted closure therapy.VAC dressing also provided the wound ready for SSG or flap rotation early as assessed by wound bed score.
{"title":"To study the outcome of low-cost negative-pressure wound therapy using wall-mounted vacuum device in the treatment of open wounds","authors":"N. Jain, R. Jain, Ajay Sabhnani","doi":"10.4103/jotr.jotr_99_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_99_22","url":null,"abstract":"Background: The Primary objective of this prospective study is to study the rate of infection, number of days required for formation of healthy granulation tissue, healing of soft tissue injury and number of days of hospital stay and cost effectiveness associated with soft tissue injury treated by Vacuum Assisted closure therapy. Methods: This is a prospective observational study of 30 patients presenting with open musculoskeletal injuries in extremities that required coverage procedures in the department of Orthopaedics, Sri Aurobindo Medical College and PG Institute, Indore. All these patients had undergone wound debridement and fracture fixation. This was followed by application of Vacuum Assisted Closure (VAC). The infection rate analysed by clinical findings and investigations. Assessment of these wound(s) were done on a regular basis by wound bed score. Assessment of rate of granulation was done on every 3rd day. Based on the rate of granulation, definitive surgical intervention (skin grafting, secondary closures and flap cover procedures) was done. The patient was sent home after performing the definitive surgical intervention. Results: The infection rate was low when compared to literature study of conventional dressings. The primary wound coverage can be done earlier wound healing was also faster in patients. Conclusion: This is a simple and low cost method for treating soft tissue injury associated with severe open fractures. It can be done even in peripheral hospitals with low resources. The rate of granulation tissue formation is good with vacuum assisted closure. Also compliance of patient is good in vacuum assisted closure therapy.VAC dressing also provided the wound ready for SSG or flap rotation early as assessed by wound bed score.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"56 1","pages":"5 - 11"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84443923","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}
Lalit Mohan, S. Vemulapalli, Chandrasekhar Patnala, Asif Syed, K. Kumar, A. Kund
A 60-year-old woman sustained right femur fracture and presented to us after taking native massage therapy for 6 weeks. Radiographs showed suspected posteromedial soft tissue shadow. Further imaging confirmed a rare pseudoaneurysm of the superficial femoral artery. After vascular surgery consultation, a single-stage procedure was planned. Through medial approach to distal femur, Pseudo aneurysm was haemodynamically isolated, opened and its contents evacuated. Neck of pseudo aneurysm is located and ligated. Distal femur plating (broad DCP) was done through the same exposure. Since traumatic pseudoaneurysms are rare entities, surgeons should have a high degree of suspicion for preoperative identification. It facilitates simultaneous vascular repair and fracture fixation. It avoids two-stage incisions, two incisions, intraoperative or postoperative catastrophe, and medicolegal complications. Hence, we advocate to look out for vascular injury in distal femur fractures at a delayed presentation.
{"title":"Successful outcome in posttraumatic superficial femoral artery pseudoaneurysm following distal femur fracture","authors":"Lalit Mohan, S. Vemulapalli, Chandrasekhar Patnala, Asif Syed, K. Kumar, A. Kund","doi":"10.4103/jotr.jotr_40_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_40_22","url":null,"abstract":"A 60-year-old woman sustained right femur fracture and presented to us after taking native massage therapy for 6 weeks. Radiographs showed suspected posteromedial soft tissue shadow. Further imaging confirmed a rare pseudoaneurysm of the superficial femoral artery. After vascular surgery consultation, a single-stage procedure was planned. Through medial approach to distal femur, Pseudo aneurysm was haemodynamically isolated, opened and its contents evacuated. Neck of pseudo aneurysm is located and ligated. Distal femur plating (broad DCP) was done through the same exposure. Since traumatic pseudoaneurysms are rare entities, surgeons should have a high degree of suspicion for preoperative identification. It facilitates simultaneous vascular repair and fracture fixation. It avoids two-stage incisions, two incisions, intraoperative or postoperative catastrophe, and medicolegal complications. Hence, we advocate to look out for vascular injury in distal femur fractures at a delayed presentation.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"13 1","pages":"109 - 111"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74865221","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: High-velocity injuries of the tibial plateau managed by operative intervention are often complicated by surgical site infections and delayed wound healing. Incisional negative pressure wound therapy (NPWT) is an established technique for the management of wound complications and is also being used nowadays for early healing of uncomplicated postoperative wounds. Materials and Methods: We conducted this study to compare the effectiveness of NPWT over conventional dressing methods by creating two groups of patients with tibial plateau fractures managed by plating. Postoperatively, NPWT was applied to one group and the other group was followed up with routine conventional dressings. Results: A total of 88 patients were included in the study, and it was found that the rate of minor and major wound site complications was more in the group of patients managed by conventional dressing. Conclusion: With our study, we concluded that in high-velocity proximal tibia fractures with a lot of soft-tissue traumas, incisional NPWT is well tolerated and has shown a definitive advantage in preventing wound-related complications as compared to regular conventional dressing.
{"title":"Comparative evaluation of postoperative incisional negative pressure wound therapy with conventional dressings in patients of proximal tibia fracture managed by dual plating","authors":"P. Kothiyal, K. Vij, P. Gupta","doi":"10.4103/jotr.jotr_93_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_93_22","url":null,"abstract":"Background: High-velocity injuries of the tibial plateau managed by operative intervention are often complicated by surgical site infections and delayed wound healing. Incisional negative pressure wound therapy (NPWT) is an established technique for the management of wound complications and is also being used nowadays for early healing of uncomplicated postoperative wounds. Materials and Methods: We conducted this study to compare the effectiveness of NPWT over conventional dressing methods by creating two groups of patients with tibial plateau fractures managed by plating. Postoperatively, NPWT was applied to one group and the other group was followed up with routine conventional dressings. Results: A total of 88 patients were included in the study, and it was found that the rate of minor and major wound site complications was more in the group of patients managed by conventional dressing. Conclusion: With our study, we concluded that in high-velocity proximal tibia fractures with a lot of soft-tissue traumas, incisional NPWT is well tolerated and has shown a definitive advantage in preventing wound-related complications as compared to regular conventional dressing.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"8 1","pages":"12 - 16"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73655155","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}
E. V. van Delft, Emilien Wegenrif, R. de Vries, J. Vermeulen, N. Schep, F. Bloemers
Purpose: Displaced distal radius fractures (DRFs) are treated by reduction and cast immobilization or by reduction and internal fixation. Both treatment options have been extensively researched in the literature, but still there is debate on the favorable treatment. Complications are infrequently described and if present, only mentioned as a minor detail. This study was initiated to provide insight into the rate of complications to add value to the discussion of the optimal treatment. Methods: A comprehensive search was conducted in three bibliographic databases. Suitable studies were randomized controlled trials (RCTs) and retrospective trials that compare reduction followed by cast immobilization or volar plating and reported on complications or suboptimal outcome. Results: Six studies, of which two RCTs and four retrospective studies, were included. In total, 467 patients with a DRF were analyzed. Wound healing problems, hardware-related complications, and removal of hardware occurred solely in patients who were treated by volar plating. Carpal tunnel syndrome, re-displacement, malunion, and severe stiffness occurred more often in the nonoperative group. No difference was found between both treatment options regarding tendon injuries, poor patient-reported outcome, distal radioulnar joint laxity-instability, and persistent pain after 1 year. The intensity of complications and patient-related factors were in general not analyzed in any of the included studies. Conclusion: Based on this systematic review on complications in the treatment of DRFs, there is no evident optimal treatment. The choice of treatment should depend on patient based, shared decision-making, taking the advantages and complications of both the nonoperative and operative treatment into account.
{"title":"Complications of the nonoperative versus operative treatment of displaced and reduced distal radius fractures in adults: A systematic review","authors":"E. V. van Delft, Emilien Wegenrif, R. de Vries, J. Vermeulen, N. Schep, F. Bloemers","doi":"10.4103/jotr.jotr_4_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_4_22","url":null,"abstract":"Purpose: Displaced distal radius fractures (DRFs) are treated by reduction and cast immobilization or by reduction and internal fixation. Both treatment options have been extensively researched in the literature, but still there is debate on the favorable treatment. Complications are infrequently described and if present, only mentioned as a minor detail. This study was initiated to provide insight into the rate of complications to add value to the discussion of the optimal treatment. Methods: A comprehensive search was conducted in three bibliographic databases. Suitable studies were randomized controlled trials (RCTs) and retrospective trials that compare reduction followed by cast immobilization or volar plating and reported on complications or suboptimal outcome. Results: Six studies, of which two RCTs and four retrospective studies, were included. In total, 467 patients with a DRF were analyzed. Wound healing problems, hardware-related complications, and removal of hardware occurred solely in patients who were treated by volar plating. Carpal tunnel syndrome, re-displacement, malunion, and severe stiffness occurred more often in the nonoperative group. No difference was found between both treatment options regarding tendon injuries, poor patient-reported outcome, distal radioulnar joint laxity-instability, and persistent pain after 1 year. The intensity of complications and patient-related factors were in general not analyzed in any of the included studies. Conclusion: Based on this systematic review on complications in the treatment of DRFs, there is no evident optimal treatment. The choice of treatment should depend on patient based, shared decision-making, taking the advantages and complications of both the nonoperative and operative treatment into account.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"11 1","pages":"50 - 56"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79818388","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: Fractures of the clavicle constitute 2.6% of all fractures, account for 44% of the injuries around the shoulder girdle, approximately 70%–80% of which occur in the middle third. Even when significantly displaced, conventionally these fractures are treated without surgery. Conservative treatments either by sling/figure of eight bandage/clavicular brace are favored by patients, but the results are much inferior to what was reported previously. The present study conducted to operate fresh fracture with displacement >2 cm, nonunion by open reduction and internal fixation (ORIF) with locking plate with or without bone grafting. The objective is relief from pain, restoration of activities as far as possible and better cosmetic appearance. Materials and Methods: Twenty-eight cases of the clavicle in healthy active individuals between 18 and 65 years of age operated between December 2019 and September 2022 in Hazaribag Medical College, Hazaribag, Jharkhand. Patients with minimally displaced fracture were excluded from the study. Fracture is classified by Allman in three groups as middle 1/3rd, distal 1/3rd, and medial 1/3rd. Indications for surgery are either open fracture, vascular injuries, initial displacement >2 cm, nonunion, cosmetically conscious patients. Results: Fifteen cases of fresh, 6 cases of symptomatic delayed union, and 7 cases of nonunion operated with precontoured plate with or without bone grafting. The average hospital stay was 3–7 days. The average time of fracture union was 10 weeks (8–12 weeks). Patients were followed weekly up to 4 weeks and then after 2 and 6 months. The functional outcome according to Constant and Murley score is excellent in 17 (60.7%) patients, good in 10 (35.7%) patients and satisfactory in 1 (3.6%) case. There was no major complication, one patient had superficial infection, deep infection in 1 case, nonunion in 1 case and plate breakage in one patient. Results were compared with cases treated conservatively. Conclusion: In the present era of competition, cosmesis and advancement with least morbidity and excellent results is required. ORIF in selected cases is a very good option in comparison to accept morbidity, cosmetic disfigurement and below-average functional results.
{"title":"Prospective study of surgical management of midshaft clavicle fractures","authors":"Pawan Kumar, Mritunjay Kumar","doi":"10.4103/jotr.jotr_6_23","DOIUrl":"https://doi.org/10.4103/jotr.jotr_6_23","url":null,"abstract":"Introduction: Fractures of the clavicle constitute 2.6% of all fractures, account for 44% of the injuries around the shoulder girdle, approximately 70%–80% of which occur in the middle third. Even when significantly displaced, conventionally these fractures are treated without surgery. Conservative treatments either by sling/figure of eight bandage/clavicular brace are favored by patients, but the results are much inferior to what was reported previously. The present study conducted to operate fresh fracture with displacement >2 cm, nonunion by open reduction and internal fixation (ORIF) with locking plate with or without bone grafting. The objective is relief from pain, restoration of activities as far as possible and better cosmetic appearance. Materials and Methods: Twenty-eight cases of the clavicle in healthy active individuals between 18 and 65 years of age operated between December 2019 and September 2022 in Hazaribag Medical College, Hazaribag, Jharkhand. Patients with minimally displaced fracture were excluded from the study. Fracture is classified by Allman in three groups as middle 1/3rd, distal 1/3rd, and medial 1/3rd. Indications for surgery are either open fracture, vascular injuries, initial displacement >2 cm, nonunion, cosmetically conscious patients. Results: Fifteen cases of fresh, 6 cases of symptomatic delayed union, and 7 cases of nonunion operated with precontoured plate with or without bone grafting. The average hospital stay was 3–7 days. The average time of fracture union was 10 weeks (8–12 weeks). Patients were followed weekly up to 4 weeks and then after 2 and 6 months. The functional outcome according to Constant and Murley score is excellent in 17 (60.7%) patients, good in 10 (35.7%) patients and satisfactory in 1 (3.6%) case. There was no major complication, one patient had superficial infection, deep infection in 1 case, nonunion in 1 case and plate breakage in one patient. Results were compared with cases treated conservatively. Conclusion: In the present era of competition, cosmesis and advancement with least morbidity and excellent results is required. ORIF in selected cases is a very good option in comparison to accept morbidity, cosmetic disfigurement and below-average functional results.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"51 1","pages":"17 - 21"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88724088","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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