U. Pradhan, S. Thejaswi, H. Naik, S. Baliga, Nikhil Sharma, Avik Chakravorty
Background: Humeral shaft fracture management has always been controversial. There are proponents for both conservative and operative management with intramedullary nailing as well as plate osteosynthesis. Anteromedial plating of shaft fractures has not been regularly described. This study was conducted to evaluate the viability of anteromedial plating as an alternative to anterolateral and posterior plating for diaphyseal humerus fractures. Materials and Methods: The study was conducted at a tertiary care center. Inclusion criteria comprised: age more than 18 years, and diaphyseal humerus fracture treated with anteromedial plating using the anterolateral approach with a minimum follow-up of 6 months. Exclusion criteria included: pathological fracture, grade open III fractures, nonunion, intra-articular fractures, preoperative radial nerve palsy, nonconsent, and loss to follow-up. Functional outcome was evaluated at 6 months using the QuickDASH score. Results: Out of 44 volunteers, 28 (64%) were male and 16 (36%) were female. The mean age of the volunteers was 36 ± 13 years. The most common fracture type encountered was 12-A2 (41%). The mean operative time was 61.27 ± 10.3 min, and the mean perioperative blood loss was 308 cm3. The mean time for the radiological union was 13.9 weeks. One patient developed postoperative radial nerve palsy. The mean DASH score at 6 months was 13.5 ± 3.2. Conclusion: Anteromedial plating humerus using anterolateral approach provides a safe and viable alternative to lateral and posterior plating with regard to operative time, perioperative blood loss, complications, and functional recovery.
{"title":"Surgical results of anteromedial plate osteosynthesis for diaphyseal humerus fracture","authors":"U. Pradhan, S. Thejaswi, H. Naik, S. Baliga, Nikhil Sharma, Avik Chakravorty","doi":"10.4103/jotr.jotr_19_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_19_22","url":null,"abstract":"Background: Humeral shaft fracture management has always been controversial. There are proponents for both conservative and operative management with intramedullary nailing as well as plate osteosynthesis. Anteromedial plating of shaft fractures has not been regularly described. This study was conducted to evaluate the viability of anteromedial plating as an alternative to anterolateral and posterior plating for diaphyseal humerus fractures. Materials and Methods: The study was conducted at a tertiary care center. Inclusion criteria comprised: age more than 18 years, and diaphyseal humerus fracture treated with anteromedial plating using the anterolateral approach with a minimum follow-up of 6 months. Exclusion criteria included: pathological fracture, grade open III fractures, nonunion, intra-articular fractures, preoperative radial nerve palsy, nonconsent, and loss to follow-up. Functional outcome was evaluated at 6 months using the QuickDASH score. Results: Out of 44 volunteers, 28 (64%) were male and 16 (36%) were female. The mean age of the volunteers was 36 ± 13 years. The most common fracture type encountered was 12-A2 (41%). The mean operative time was 61.27 ± 10.3 min, and the mean perioperative blood loss was 308 cm3. The mean time for the radiological union was 13.9 weeks. One patient developed postoperative radial nerve palsy. The mean DASH score at 6 months was 13.5 ± 3.2. Conclusion: Anteromedial plating humerus using anterolateral approach provides a safe and viable alternative to lateral and posterior plating with regard to operative time, perioperative blood loss, complications, and functional recovery.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"1 1","pages":"78 - 81"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89891424","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_129_22
P. Patil, Umesh Jain, Amol Gowaikar, S. Lad, Shivaji Kolli
Background: The arm and forearm not in straight line when the elbow is completely extended and supinated; rather, it is displaced to lateral, and an angle known as carrying angle created between long axis of arm and forearm. Among children most common type of fracture seen in the elbow region is Supracondylar fracture. Any mal-union or Inaccurate reduction in these fracture will result in disabling and unsightly cubitus varus deformity. In order to prevent such defects pre-operative assessment of the deformity need to be done with a knowledge of carrying angle at that particular age of the children. Objectives: To define the normal values of the elbow carrying angle in particular age groups among children. Materials and Methods: The present cross sectional study was conducted by the Department of orthopaedics, Dr. D. Y. Patil Hospital at Kolhapur from January 2021 to June 2022. A total of 1000 children who belonged to aged group of 8 to 16 years of age were evaluated for the measurement of carrying angle during the study period by probability sampling with equal distribution of subjects in both the gender and in the age group of 8-16years. Results: The elbow carrying angle was found to be progressively increasing with the age among both the boys and girls and the difference was found to be statistically insignificant till 12 years. The Carrying angle showed peak around the age of 14 years and plateaued and further there was decrease in the angle as age advances. The correlation coefficient r is highest with age in boys and girls while the r values with other variables show only negligible correlation. Conclusion: Overall, it is approved that elbow carrying angle increased with age due to skeletal maturity. The gender, elbow carrying angle is usually higher in girls compared to boys; respectively however, it can't be same always cause of inter-observer and individual variability.
背景:肘关节完全伸展和旋后时，手臂和前臂不在一条直线上;相反，它被移向外侧，并且在手臂长轴和前臂之间形成一个称为携带角的角度。在儿童中，肘部最常见的骨折类型是髁上骨折。这些骨折的任何不正常愈合或复位不准确都会导致致残和难看的肘内翻畸形。为了防止此类缺陷，术前畸形评估需要了解特定年龄儿童的负重角度。目的:探讨特定年龄组儿童肘部抬角的正常值。材料和方法:本横断面研究由Kolhapur Dr. D. Y. Patil医院骨科于2021年1月至2022年6月进行。采用概率抽样的方法，对研究期间1000名8 ~ 16岁儿童进行负重角测量，受试者性别和8 ~ 16岁年龄均为均匀分布。结果:男孩和女孩的抬肘角度均随年龄的增长而逐渐增加，到12岁时差异无统计学意义。携带角在14岁左右达到峰值后趋于平稳，随着年龄的增长，携带角逐渐减小。男孩和女孩的相关系数r与年龄相关最高，而与其他变量的相关系数r值可以忽略不计。结论:总的来说，由于骨骼的成熟，肘部携带角度随着年龄的增长而增加。性别，女生抬肘的角度通常比男生高;然而，由于观察者之间和个体的可变性，它不可能总是一样的。
{"title":"A study to assess the carrying angle in children aged between 8 to 16 years of age","authors":"P. Patil, Umesh Jain, Amol Gowaikar, S. Lad, Shivaji Kolli","doi":"10.4103/jotr.jotr_129_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_129_22","url":null,"abstract":"Background: The arm and forearm not in straight line when the elbow is completely extended and supinated; rather, it is displaced to lateral, and an angle known as carrying angle created between long axis of arm and forearm. Among children most common type of fracture seen in the elbow region is Supracondylar fracture. Any mal-union or Inaccurate reduction in these fracture will result in disabling and unsightly cubitus varus deformity. In order to prevent such defects pre-operative assessment of the deformity need to be done with a knowledge of carrying angle at that particular age of the children. Objectives: To define the normal values of the elbow carrying angle in particular age groups among children. Materials and Methods: The present cross sectional study was conducted by the Department of orthopaedics, Dr. D. Y. Patil Hospital at Kolhapur from January 2021 to June 2022. A total of 1000 children who belonged to aged group of 8 to 16 years of age were evaluated for the measurement of carrying angle during the study period by probability sampling with equal distribution of subjects in both the gender and in the age group of 8-16years. Results: The elbow carrying angle was found to be progressively increasing with the age among both the boys and girls and the difference was found to be statistically insignificant till 12 years. The Carrying angle showed peak around the age of 14 years and plateaued and further there was decrease in the angle as age advances. The correlation coefficient r is highest with age in boys and girls while the r values with other variables show only negligible correlation. Conclusion: Overall, it is approved that elbow carrying angle increased with age due to skeletal maturity. The gender, elbow carrying angle is usually higher in girls compared to boys; respectively however, it can't be same always cause of inter-observer and individual variability.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"136 1","pages":"88 - 91"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76437537","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}
Prolotherapy is one of the injection-based alternative therapeutic options for the treatment of chronic musculoskeletal pain. However, for chronic musculoskeletal conditions, corticosteroid and local anesthetic preparation like Lignocaine is widespread and initial injection therapy of choice. There are several other techniques also such as autologous whole blood, platelet-rich plasma, bone marrow, dry needling, and extracorporeal wave therapy. In prolotherapy, a very small amount of irritant or sclerosing solution is injected into joint space, ligament, or tendon insertion sites as a complementary medical treatment over several treatment seasons. Hyperosmolar dextrose, phenol–glycerine–glucose, and morrhuate sodium are the three most commonly used prolotherapy solutions. There are several studies and evidence available regarding the efficacy of prolotherapy over various musculoskeletal conditions such as chronic low back pain, osteoarthritis of joints, subluxation and joint instability, ligament laxity, hypermobility of joints, and tendinopathy. The efficacy of prolotherapy for different musculoskeletal conditions with different injections is different, and the precise mechanism of prolotherapy effect is still not clear, so further studies and clinical trials are recommended.
{"title":"Effectiveness of prolotherapy for chronic musculoskeletal conditions","authors":"S. Agarwal, A. Nagaich, Nikhil Jain, A. Shah","doi":"10.4103/jotr.jotr_4_23","DOIUrl":"https://doi.org/10.4103/jotr.jotr_4_23","url":null,"abstract":"Prolotherapy is one of the injection-based alternative therapeutic options for the treatment of chronic musculoskeletal pain. However, for chronic musculoskeletal conditions, corticosteroid and local anesthetic preparation like Lignocaine is widespread and initial injection therapy of choice. There are several other techniques also such as autologous whole blood, platelet-rich plasma, bone marrow, dry needling, and extracorporeal wave therapy. In prolotherapy, a very small amount of irritant or sclerosing solution is injected into joint space, ligament, or tendon insertion sites as a complementary medical treatment over several treatment seasons. Hyperosmolar dextrose, phenol–glycerine–glucose, and morrhuate sodium are the three most commonly used prolotherapy solutions. There are several studies and evidence available regarding the efficacy of prolotherapy over various musculoskeletal conditions such as chronic low back pain, osteoarthritis of joints, subluxation and joint instability, ligament laxity, hypermobility of joints, and tendinopathy. The efficacy of prolotherapy for different musculoskeletal conditions with different injections is different, and the precise mechanism of prolotherapy effect is still not clear, so further studies and clinical trials are recommended.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"18 1","pages":"1 - 4"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78027659","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: Increased body weight, repeated micro trauma and work on hard surfaces are the risk factors for plantar fasciitis. Platelet rich plasma (PRP) can be injected to various tissues where it releases high amounts of platelet derived growth factors that increases growth and healing process. Low level laser therapy (LLLT) is an alternative treatment that uses low power lasers. Potential benefits in reducing the pain and spasm. Methodology: Patients between 18 to 60 years were included in this prospective randomized controlled trial. Diagnosis made mainly on clinical grounds. We divided our patients in two groups randomly using simple number random method. GROUP-A patients treated with PRP along with laser therapy. GROUP-B treated with laser therapy only. We used visual analogue scale (VAS) and foot and ankle disability (FAD) index for assessment of pain relief during follow up. Results: 88 patients were included in this study. The VAS score was significantly (P<0.05) become lower in Group A patients as compared with Group B and significant increase in FAD index (P<0.01) among the Group A patients as compare to Group B from prior to infiltration and at follow up. Conclusion: In these patients local infiltration with platelet rich plasma has yielded good results. Low level light therapy also can be used for treating planter fasciitis, but better result found when it given together.
{"title":"To compare the efficacy of platelet-rich plasma with low-level laser therapy and low-level laser therapy alone in the treatment of chronic plantar fasciitis","authors":"Sushila Saini, A. Saroj, Ashutosh Verma","doi":"10.4103/jotr.jotr_19_23","DOIUrl":"https://doi.org/10.4103/jotr.jotr_19_23","url":null,"abstract":"Background: Increased body weight, repeated micro trauma and work on hard surfaces are the risk factors for plantar fasciitis. Platelet rich plasma (PRP) can be injected to various tissues where it releases high amounts of platelet derived growth factors that increases growth and healing process. Low level laser therapy (LLLT) is an alternative treatment that uses low power lasers. Potential benefits in reducing the pain and spasm. Methodology: Patients between 18 to 60 years were included in this prospective randomized controlled trial. Diagnosis made mainly on clinical grounds. We divided our patients in two groups randomly using simple number random method. GROUP-A patients treated with PRP along with laser therapy. GROUP-B treated with laser therapy only. We used visual analogue scale (VAS) and foot and ankle disability (FAD) index for assessment of pain relief during follow up. Results: 88 patients were included in this study. The VAS score was significantly (P<0.05) become lower in Group A patients as compared with Group B and significant increase in FAD index (P<0.01) among the Group A patients as compare to Group B from prior to infiltration and at follow up. Conclusion: In these patients local infiltration with platelet rich plasma has yielded good results. Low level light therapy also can be used for treating planter fasciitis, but better result found when it given together.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"2012 1","pages":"73 - 77"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86359729","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: Both Scoliosis Research Society-22 (SRS-22) questionnaire (on patients' outcome) and Scoliosis Appearance Questionnaire (SAQ) (on patients' appearance) were well-accepted and well-validated patient-reported outcome measures. Our center administered both to severe adolescent idiopathic scoliosis (AIS) patients who underwent spinal correction. In view of a total of 14 (9 + 5) major domain scores from both questionnaires, this study attempted to develop new composite indexes using factor analysis. Materials and Methods: All operated AIS patients within the years 2014 and 2016 were recruited. Patients were administered both SRS-22 questionnaire and SAQ before surgery, before discharge after surgery, 1 year after surgery, and 2 years after surgery. Factor analysis without rotation was carried out and identified a total of 12 factorable domains. Factor analysis with rotation on the 12 domains was followed. Descriptive statistics and reliability analysis on the loaded factors (composite indexes) were calculated. Results: There were 135 severe AIS patients recruited in this study, of which 74.1% were female, and the mean age at operation was 15.97. Two factors were yielded after factor analysis (KMO = 0.633 and Bartlett's Test of Sphericity < 0.001) with orthogonal rotation. “Trunk symmetry and health-related quality of life (HRQOL)” loaded with 2 SAQ and all 5 SRS-22 scores, and 5 SAQ scores in “Body appearance.” Reliability tests showed very strong internal consistency. Skewness and kurtosis showed data in both indexes were normally distributed. Conclusions: Two composite indexes “Trunk symmetry and HRQOL” and “Body appearance” were loaded after factor analysis of 12 domains from SRS-22 and SAQ. Both composite scores were reliable and normally distributed. The development of the new composite indexes “Trunk symmetry and HRQOL” and “Body appearance” simplifies result interpretation without losing the characteristics of SRS-22 and SAQ. Results can be interpreted in the same direction.
{"title":"New composite indexes through factor analysis simplifying the interpretation of health-related quality of life outcomes of surgical adolescent idiopathic scoliosis patients completing both scoliosis research society-22 and SAQ questionnaires longitudinally","authors":"W. Chau, B. Ng","doi":"10.4103/jotr.jotr_5_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_5_22","url":null,"abstract":"Background: Both Scoliosis Research Society-22 (SRS-22) questionnaire (on patients' outcome) and Scoliosis Appearance Questionnaire (SAQ) (on patients' appearance) were well-accepted and well-validated patient-reported outcome measures. Our center administered both to severe adolescent idiopathic scoliosis (AIS) patients who underwent spinal correction. In view of a total of 14 (9 + 5) major domain scores from both questionnaires, this study attempted to develop new composite indexes using factor analysis. Materials and Methods: All operated AIS patients within the years 2014 and 2016 were recruited. Patients were administered both SRS-22 questionnaire and SAQ before surgery, before discharge after surgery, 1 year after surgery, and 2 years after surgery. Factor analysis without rotation was carried out and identified a total of 12 factorable domains. Factor analysis with rotation on the 12 domains was followed. Descriptive statistics and reliability analysis on the loaded factors (composite indexes) were calculated. Results: There were 135 severe AIS patients recruited in this study, of which 74.1% were female, and the mean age at operation was 15.97. Two factors were yielded after factor analysis (KMO = 0.633 and Bartlett's Test of Sphericity < 0.001) with orthogonal rotation. “Trunk symmetry and health-related quality of life (HRQOL)” loaded with 2 SAQ and all 5 SRS-22 scores, and 5 SAQ scores in “Body appearance.” Reliability tests showed very strong internal consistency. Skewness and kurtosis showed data in both indexes were normally distributed. Conclusions: Two composite indexes “Trunk symmetry and HRQOL” and “Body appearance” were loaded after factor analysis of 12 domains from SRS-22 and SAQ. Both composite scores were reliable and normally distributed. The development of the new composite indexes “Trunk symmetry and HRQOL” and “Body appearance” simplifies result interpretation without losing the characteristics of SRS-22 and SAQ. Results can be interpreted in the same direction.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"33 1","pages":"33 - 39"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88874671","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: Hip fractures are the major cause of disability and functional impairment in the elderly. Studies have correlated the results from treating femoral neck fractures; however, little has been described the quality of life (QOL) after hemiarthroplasty in these patients. Objective: An assessment of physical, psychological, social relationships, and environmental domains of QOL after hemiarthroplasty in elderly patients and to analyze the postsurgical impact on the activity of daily living and functional outcome of the hip. Methods: Prospective observational study was conducted on 100 elderly patients who underwent hemiarthroplasty. The hip function was scored with the Harris Hip Score (HHS) and activities of daily living were rated by the Barthel Index. Health-related QOL was rated by the World Health Organization QOL: Brief version applied before and 6 months after surgery. Results: There was fair to good HHS and decreased dependency in the activities of daily living with preserved function by the end of 6 months. Postsurgery ambulation showed that 30% of them used a walker for ambulation due to fear of falls. QOL improved but did not return to presurgery levels. The psychological domain was the most affected, followed by the environmental and social domains. Conclusion: Results showed the need for improvisation of various aspects of postoperative care such as designated rehabilitation protocols, fall clinics, psychotherapy and relaxation, and geriatric care for associated comorbidities. Implementing such a comprehensive specialty care approach along with good surgery will improve the QOL to presurgical level.
{"title":"Are we really improving the quality of life after hemiarthroplasty of the hip in the elderly? An observational study","authors":"T. Adarsh, Mruthyunjaya, C. Likhit, N. Khan","doi":"10.4103/jotr.jotr_32_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_32_22","url":null,"abstract":"Introduction: Hip fractures are the major cause of disability and functional impairment in the elderly. Studies have correlated the results from treating femoral neck fractures; however, little has been described the quality of life (QOL) after hemiarthroplasty in these patients. Objective: An assessment of physical, psychological, social relationships, and environmental domains of QOL after hemiarthroplasty in elderly patients and to analyze the postsurgical impact on the activity of daily living and functional outcome of the hip. Methods: Prospective observational study was conducted on 100 elderly patients who underwent hemiarthroplasty. The hip function was scored with the Harris Hip Score (HHS) and activities of daily living were rated by the Barthel Index. Health-related QOL was rated by the World Health Organization QOL: Brief version applied before and 6 months after surgery. Results: There was fair to good HHS and decreased dependency in the activities of daily living with preserved function by the end of 6 months. Postsurgery ambulation showed that 30% of them used a walker for ambulation due to fear of falls. QOL improved but did not return to presurgery levels. The psychological domain was the most affected, followed by the environmental and social domains. Conclusion: Results showed the need for improvisation of various aspects of postoperative care such as designated rehabilitation protocols, fall clinics, psychotherapy and relaxation, and geriatric care for associated comorbidities. Implementing such a comprehensive specialty care approach along with good surgery will improve the QOL to presurgical level.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"39 1","pages":"63 - 67"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73665112","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}
S. Rajan, Saurabh Jain, Chetan Dhosariya, A. Goyal
Introduction: Outpatient total knee arthroplasty (TKA) in selected patients has proved to be beneficial to both patients and health-care systems in terms of safety, reoperations, readmission rate, complications, cost-effectiveness, increased patient satisfaction, and improved outcome scores. However, these benefits of outpatient TKA have been limited to unilateral TKA. Hence, we reviewed the results of bilateral outpatient TKA in five patients to educate surgeons about the feasibility, safety, benefit, and area of research for bilateral outpatient TKA and its worth consideration in selected groups of patients to decrease patient morbidity and cost. Materials and Methods: Five bilateral knee arthroplasties done as outpatient surgeries at our center were reviewed for patient satisfaction, readmission, reoperation, emergency visit without readmission, unplanned clinic visits, and complications. All these cases followed proper selection criteria, adequate preoperative planning, and strict adherence to our standard operating protocols. Results: Five patients of bilateral outpatient TKA with a mean age of 48.6 years were included in the study. All patients have excellent outcomes at 1-month follow-up. The mean Knee Society Score was 91. None of the patients required reoperation or revision surgery. All the patients demonstrated a high level of satisfaction, without any complications of instability, infection, ileus, urinary tract infection, or deep vein thrombosis. Conclusion: Bilateral outpatient TKA can be considered a suitable alternative with benefits of reduced hospital stay, and hence decreased morbidity and cost, early mobilization and recovery, economical advantages, minimal pain owing to multimodal analgesia, faster return to normalcy, and less mental stress or disturbances, but in selected patients at specialized center only. The study stresses on the fact of bilateral outpatient TKA should also considered a key area of research in the field of outpatient TKA in addition to other areas of universal selection criteria, ideal risk assessment tool, safety aspect, surgical duration, ambulation, and reasons for not able to discharge.
{"title":"Bilateral outpatient total knee arthroplasty – Is it feasible, safe, and worth considering: A pilot study","authors":"S. Rajan, Saurabh Jain, Chetan Dhosariya, A. Goyal","doi":"10.4103/jotr.jotr_21_23","DOIUrl":"https://doi.org/10.4103/jotr.jotr_21_23","url":null,"abstract":"Introduction: Outpatient total knee arthroplasty (TKA) in selected patients has proved to be beneficial to both patients and health-care systems in terms of safety, reoperations, readmission rate, complications, cost-effectiveness, increased patient satisfaction, and improved outcome scores. However, these benefits of outpatient TKA have been limited to unilateral TKA. Hence, we reviewed the results of bilateral outpatient TKA in five patients to educate surgeons about the feasibility, safety, benefit, and area of research for bilateral outpatient TKA and its worth consideration in selected groups of patients to decrease patient morbidity and cost. Materials and Methods: Five bilateral knee arthroplasties done as outpatient surgeries at our center were reviewed for patient satisfaction, readmission, reoperation, emergency visit without readmission, unplanned clinic visits, and complications. All these cases followed proper selection criteria, adequate preoperative planning, and strict adherence to our standard operating protocols. Results: Five patients of bilateral outpatient TKA with a mean age of 48.6 years were included in the study. All patients have excellent outcomes at 1-month follow-up. The mean Knee Society Score was 91. None of the patients required reoperation or revision surgery. All the patients demonstrated a high level of satisfaction, without any complications of instability, infection, ileus, urinary tract infection, or deep vein thrombosis. Conclusion: Bilateral outpatient TKA can be considered a suitable alternative with benefits of reduced hospital stay, and hence decreased morbidity and cost, early mobilization and recovery, economical advantages, minimal pain owing to multimodal analgesia, faster return to normalcy, and less mental stress or disturbances, but in selected patients at specialized center only. The study stresses on the fact of bilateral outpatient TKA should also considered a key area of research in the field of outpatient TKA in addition to other areas of universal selection criteria, ideal risk assessment tool, safety aspect, surgical duration, ambulation, and reasons for not able to discharge.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"24 1","pages":"68 - 72"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75399307","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}
Study Design: This was a prospective cohort study. Purpose: The purpose of this study was to evaluate the efficacy of surgical treatment in nontuberculous spondylodiscitis and its effects on the functional and radiological outcomes and define a treatment algorithm. Overview of Literature: Most of the available literature on surgical management of nontuberculous spondylodiscitis is retrospective in nature. A prospective study analyzing functional (Oswestry Disability Index [ODI] and Visual Analog Scale [VAS]) and radiological outcomes of surgical intervention is scanty in the literature. Materials and Methods: A prospective analysis of 22 patients was performed who underwent surgical intervention for biopsy-proven nontuberculous spondylodiscitis. Preoperative ODI and VAS scores were compared with that at 1-year postoperative follow-up. Microbiological details of each patient were noted. Radiological evidence of healing was reported at the final 1-year follow-up. Results: Of 22 patients, 12 were male and the remaining were female, with a ratio of 1.2:1. The average age was 58 years. The most common region of involvement was lumbosacral followed by dorsal and cervical. All the patients underwent single-stage surgery. Microbiological studies showed growth in only 16 patients (72.7%). Staphylococcus aureus was the most common organism isolated. The mean VAS score before surgery was 8.9 which improved to 2.05 at 1-year follow-up. Similarly, the mean ODI score improved from 86.64% to 20.65% at 1-year follow-up with significant P < 0.01. Two patients needed revision for implant loosening. At the final follow-up, all patients had radiological evidence of bony consolidation. Conclusions: The study highlights improved outcomes with surgical intervention combined with appropriate antibiotics. With minimal complication rates, increased stability achieved following surgery alludes to good pain control and hence early mobilization. However, there is a grave concern about culture-negative spondylodiscitis which can lead to poor outcomes. Hence there is a need for further multicentre studies to strategize management of these cases.
{"title":"Spinal instrumentation in the setting of nontuberculous spondylodiscitis: A prospective analysis","authors":"H. Prasad, P. Murthy, V. Varma, A. Reddy","doi":"10.4103/jotr.jotr_11_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_11_22","url":null,"abstract":"Study Design: This was a prospective cohort study. Purpose: The purpose of this study was to evaluate the efficacy of surgical treatment in nontuberculous spondylodiscitis and its effects on the functional and radiological outcomes and define a treatment algorithm. Overview of Literature: Most of the available literature on surgical management of nontuberculous spondylodiscitis is retrospective in nature. A prospective study analyzing functional (Oswestry Disability Index [ODI] and Visual Analog Scale [VAS]) and radiological outcomes of surgical intervention is scanty in the literature. Materials and Methods: A prospective analysis of 22 patients was performed who underwent surgical intervention for biopsy-proven nontuberculous spondylodiscitis. Preoperative ODI and VAS scores were compared with that at 1-year postoperative follow-up. Microbiological details of each patient were noted. Radiological evidence of healing was reported at the final 1-year follow-up. Results: Of 22 patients, 12 were male and the remaining were female, with a ratio of 1.2:1. The average age was 58 years. The most common region of involvement was lumbosacral followed by dorsal and cervical. All the patients underwent single-stage surgery. Microbiological studies showed growth in only 16 patients (72.7%). Staphylococcus aureus was the most common organism isolated. The mean VAS score before surgery was 8.9 which improved to 2.05 at 1-year follow-up. Similarly, the mean ODI score improved from 86.64% to 20.65% at 1-year follow-up with significant P < 0.01. Two patients needed revision for implant loosening. At the final follow-up, all patients had radiological evidence of bony consolidation. Conclusions: The study highlights improved outcomes with surgical intervention combined with appropriate antibiotics. With minimal complication rates, increased stability achieved following surgery alludes to good pain control and hence early mobilization. However, there is a grave concern about culture-negative spondylodiscitis which can lead to poor outcomes. Hence there is a need for further multicentre studies to strategize management of these cases.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"10 1","pages":"92 - 97"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72752358","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. Kushwaha, Sushila Saini, Ashutosh Verma, R. Mohan, A. Saroj, Arpit Singh, M. Prajwal
Background: Increased risk of proximal humerus fractures are seen in elderly group as their bones are osteoporotic or brittle. Mode of trauma in elderly patients with severe osteoporosis, fractures usually resulted from low velocity indirect trauma while high velocity trauma like road traffic accident was the cause of these fractures in younger age group. Surgery can be an option to obtain a better functional outcome or when a complex fracture needs to be fixed. With the advantages and the paucity of data on the functional outcome and efficacy of the following internal fixation with the PHILOS plate for displaced proximal humerus fractures in mind, the present study was planned. Methodology: Patients who fulfilled the selection criteria were informed about the study and were then enrolled. Following the surgery, patients were followed up regularly at six weeks, three months, and six months. Final outcome was analyzed by Constant Shoulder Score. Christopher Constant, with the help of the late Alan Murley during the years 1981–1986, devised the Constant Score, which was first presented in a university thesis in 1986 and whose methodology was later published in 1987. Results: A total of 30 patients sustained with proximal humerus fractures were studied. In this study of final assessment were Found 73.2 % good to excellent outcome by using the Constant Shoulder Score. Conclusion: Following this study, the inference can be drawn that proximal humerus internal locking system for the management of proximal humerus fractures give a good functional outcome in most patients. Hence PHILOS plate application for fixation of fracture proximal humerus in elderly patients hence allowing early mobilization of the shoulder.
{"title":"Functional outcome of osteosynthesis with PHILOS in elderly patients: Experience at tertiary care centre","authors":"N. Kushwaha, Sushila Saini, Ashutosh Verma, R. Mohan, A. Saroj, Arpit Singh, M. Prajwal","doi":"10.4103/jotr.jotr_48_23","DOIUrl":"https://doi.org/10.4103/jotr.jotr_48_23","url":null,"abstract":"Background: Increased risk of proximal humerus fractures are seen in elderly group as their bones are osteoporotic or brittle. Mode of trauma in elderly patients with severe osteoporosis, fractures usually resulted from low velocity indirect trauma while high velocity trauma like road traffic accident was the cause of these fractures in younger age group. Surgery can be an option to obtain a better functional outcome or when a complex fracture needs to be fixed. With the advantages and the paucity of data on the functional outcome and efficacy of the following internal fixation with the PHILOS plate for displaced proximal humerus fractures in mind, the present study was planned. Methodology: Patients who fulfilled the selection criteria were informed about the study and were then enrolled. Following the surgery, patients were followed up regularly at six weeks, three months, and six months. Final outcome was analyzed by Constant Shoulder Score. Christopher Constant, with the help of the late Alan Murley during the years 1981–1986, devised the Constant Score, which was first presented in a university thesis in 1986 and whose methodology was later published in 1987. Results: A total of 30 patients sustained with proximal humerus fractures were studied. In this study of final assessment were Found 73.2 % good to excellent outcome by using the Constant Shoulder Score. Conclusion: Following this study, the inference can be drawn that proximal humerus internal locking system for the management of proximal humerus fractures give a good functional outcome in most patients. Hence PHILOS plate application for fixation of fracture proximal humerus in elderly patients hence allowing early mobilization of the shoulder.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"47 1","pages":"57 - 62"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80743292","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: Lumbar spinal stenosis (LSS) is a clinical syndrome with neurogenic claudication, low back ache, with radiating pain to lower limbs, due to a decrease in spinal canal dimensions. Degeneration is the most common etiology, resulting due to facet joint arthropathy and intervertebral disc protrusion. Surgical intervention should be considered when conservative methods fail or if there is a progressive worsening of signs or symptoms. Most of surgical techniques are based on the principles of decompression with or without stabilization and fusion. Two or more levels of laminectomy with stabilization and fusion provide effective spinal stability but have limited adverse effect. Methodology: This is a study of 40 patients with lumbar canal stenosis, who were admitted in Thoothukudi Medical College Hospital, from July 01, 2016, to August 01, 2022. The patients admitted were allocated alternatively into two groups, decompression alone and decompression with stabilization/fusion with 20 cases each, respectively. Results: Both the groups were analyzed preoperatively and postoperatively based on demographic criteria and on clinical history, radiographic angle measurements, and Oswestry Disability Index. Conclusion: The diagnosis of LSS is often challenging and requires proper clinical assessment of the patients and their symptoms and correlates with the radiological findings. Considering these, we suggest decompression alone may be considered rather than stabilization and fusion in patients with less than two-level stenosis and stabilization with fusion more than two levels.
{"title":"Functional and radiological outcome of surgical management in lumbar spinal stenosis – A comparative study","authors":"M. Sriraghavan, Kandasamy Natesan, Pavalan Louis, Harish Punniakotti, Naveenraj Venkidusamy, Namala Bharadwaj","doi":"10.4103/jotr.jotr_110_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_110_22","url":null,"abstract":"Background: Lumbar spinal stenosis (LSS) is a clinical syndrome with neurogenic claudication, low back ache, with radiating pain to lower limbs, due to a decrease in spinal canal dimensions. Degeneration is the most common etiology, resulting due to facet joint arthropathy and intervertebral disc protrusion. Surgical intervention should be considered when conservative methods fail or if there is a progressive worsening of signs or symptoms. Most of surgical techniques are based on the principles of decompression with or without stabilization and fusion. Two or more levels of laminectomy with stabilization and fusion provide effective spinal stability but have limited adverse effect. Methodology: This is a study of 40 patients with lumbar canal stenosis, who were admitted in Thoothukudi Medical College Hospital, from July 01, 2016, to August 01, 2022. The patients admitted were allocated alternatively into two groups, decompression alone and decompression with stabilization/fusion with 20 cases each, respectively. Results: Both the groups were analyzed preoperatively and postoperatively based on demographic criteria and on clinical history, radiographic angle measurements, and Oswestry Disability Index. Conclusion: The diagnosis of LSS is often challenging and requires proper clinical assessment of the patients and their symptoms and correlates with the radiological findings. Considering these, we suggest decompression alone may be considered rather than stabilization and fusion in patients with less than two-level stenosis and stabilization with fusion more than two levels.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"107 1","pages":"98 - 105"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90636862","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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