Gautam Kumar, Biju Jacob, J. Edakalathur, L. Chandy, R. Simon
Background: The fixation of posterior tibial avulsion fractures has been predominantly open reduction and internal fixation that leads to longer incision, severe scarring and higher risk to neurovascular injury while using the posterior approach. The arthroscopic methods have a steep learning curve, and fracture fixation is usually with fibre wire. Aim: Ultrasound assisted fixation of PCL avulsion fracture. Material and Methods: The patient is placed prone; the limb is placed in 20-degree flexion and neutral rotation. The US is used to identify the popliteal artery and nerve. The blunt tip of a K wire is inserted under US guidance. After confirming the position with an image intensifier, a 3.5 mm cannulated screwdriver is passed over the K wire. The final reduction is confirmed with image intensifier in anteroposterior and lateral views. Results: We present 11 cases of the posterior tibial avulsion fracture, which have been fixed with percutaneous screw fixation. The procedure was done under image intensifier guidance and ultrasound assistance. We have a minimum 1 year and a maximum of 10 years of follow up, where most of the patients had an excellent outcome. Conclusion: The authors felt with the ultrasound-assisted fixation technique, there is minimal or no scarring with stronger fixation. The procedure is safe, devoid of morbidities associated with open reduction and can be easily replicated at most trauma centers.
{"title":"An ultrasound-assisted technique to fix the avulsion fracture of the posterior tibial spine","authors":"Gautam Kumar, Biju Jacob, J. Edakalathur, L. Chandy, R. Simon","doi":"10.4103/jotr.jotr_58_21","DOIUrl":"https://doi.org/10.4103/jotr.jotr_58_21","url":null,"abstract":"Background: The fixation of posterior tibial avulsion fractures has been predominantly open reduction and internal fixation that leads to longer incision, severe scarring and higher risk to neurovascular injury while using the posterior approach. The arthroscopic methods have a steep learning curve, and fracture fixation is usually with fibre wire. Aim: Ultrasound assisted fixation of PCL avulsion fracture. Material and Methods: The patient is placed prone; the limb is placed in 20-degree flexion and neutral rotation. The US is used to identify the popliteal artery and nerve. The blunt tip of a K wire is inserted under US guidance. After confirming the position with an image intensifier, a 3.5 mm cannulated screwdriver is passed over the K wire. The final reduction is confirmed with image intensifier in anteroposterior and lateral views. Results: We present 11 cases of the posterior tibial avulsion fracture, which have been fixed with percutaneous screw fixation. The procedure was done under image intensifier guidance and ultrasound assistance. We have a minimum 1 year and a maximum of 10 years of follow up, where most of the patients had an excellent outcome. Conclusion: The authors felt with the ultrasound-assisted fixation technique, there is minimal or no scarring with stronger fixation. The procedure is safe, devoid of morbidities associated with open reduction and can be easily replicated at most trauma centers.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"43 1","pages":"44 - 49"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84421478","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}
Posteromedial bowing of the tibia is a relatively uncommon congenital anomaly. Etiology is not fully understood. Usually, the deformity improves with time and most of the cases are managed conservatively with modifications in shoes. In case of any residual deformity or significant limb length discrepancy, there is a need of surgical procedures either to retard the growth of the normal limb by epiphysiodesis or lengthening of the affected limb using the principles of distraction osteogenesis. Here, we are reporting a rare presentation of posteromedial bowing of the tibia in the unilateral leg managed by conservative measures.
{"title":"Congenital unilateral posteromedial bowing of tibia in an adolescent: A rare presentation of tibial bowing","authors":"Nikhil Jain, Nibin Sunny, Pranjal Mishra","doi":"10.4103/jotr.jotr_88_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_88_22","url":null,"abstract":"Posteromedial bowing of the tibia is a relatively uncommon congenital anomaly. Etiology is not fully understood. Usually, the deformity improves with time and most of the cases are managed conservatively with modifications in shoes. In case of any residual deformity or significant limb length discrepancy, there is a need of surgical procedures either to retard the growth of the normal limb by epiphysiodesis or lengthening of the affected limb using the principles of distraction osteogenesis. Here, we are reporting a rare presentation of posteromedial bowing of the tibia in the unilateral leg managed by conservative measures.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"15 1","pages":"106 - 108"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84723919","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}
L. Chodavarapu, K. Kumar, Venkatesham Bitla, Chandrashekhar Patnala
Background: Arthroscopic Bankart repair is now the standard procedure for shoulder stabilization in patients with recurrent anterior shoulder instability with Bankart lesion with minimum glenoid bone loss. Aims: The aim of this study is to evaluate the postoperative shoulder motion and functional outcome following arthroscopic repair of Bankart lesion with suture anchors with or without remplissage. Materials and Methods: This is a prospective study done between May 2019 and April 2021. A total of 20 patients with recurrent anterior shoulder instability were stabilized arthroscopically by the same surgical team over time. All patients met the inclusion criteria and were assessed with the American Shoulder and Elbow Surgeons (ASES) and Rowe scoring systems. The range of motion, postoperative function, recurrence rate, and return to preinjury activities were evaluated. Results: In our study, all 20 patients were followed up for a minimum period of 1 year. All patients had a good range of motion. The two shoulder scores (ASES and Rowe) significantly improved after surgery (P < 0.05). There was only one recurrence (5%). Patients were able to return to their previous activities or physically demanding jobs. Conclusions: Arthroscopic Bankart repair for traumatic anterior shoulder instability is a good procedure with less postoperative morbidity and excellent functional outcome. It allows return of patients to previous activities without any restriction.
{"title":"Functional outcome of arthroscopic bankart repair with or without remplissage in recurrent anterior shoulder instability","authors":"L. Chodavarapu, K. Kumar, Venkatesham Bitla, Chandrashekhar Patnala","doi":"10.4103/jotr.jotr_89_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_89_22","url":null,"abstract":"Background: Arthroscopic Bankart repair is now the standard procedure for shoulder stabilization in patients with recurrent anterior shoulder instability with Bankart lesion with minimum glenoid bone loss. Aims: The aim of this study is to evaluate the postoperative shoulder motion and functional outcome following arthroscopic repair of Bankart lesion with suture anchors with or without remplissage. Materials and Methods: This is a prospective study done between May 2019 and April 2021. A total of 20 patients with recurrent anterior shoulder instability were stabilized arthroscopically by the same surgical team over time. All patients met the inclusion criteria and were assessed with the American Shoulder and Elbow Surgeons (ASES) and Rowe scoring systems. The range of motion, postoperative function, recurrence rate, and return to preinjury activities were evaluated. Results: In our study, all 20 patients were followed up for a minimum period of 1 year. All patients had a good range of motion. The two shoulder scores (ASES and Rowe) significantly improved after surgery (P < 0.05). There was only one recurrence (5%). Patients were able to return to their previous activities or physically demanding jobs. Conclusions: Arthroscopic Bankart repair for traumatic anterior shoulder instability is a good procedure with less postoperative morbidity and excellent functional outcome. It allows return of patients to previous activities without any restriction.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"59 1","pages":"144 - 148"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89350764","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 : 2022-07-01DOI: 10.4103/jotr.jotr_115_22
A. Agrawal, A. Behera, E. Mohapatra, H. Sakale, Seema K Shah, Bikram Kar, M. Ojha, B. Nayak, A. Garg
Introduction: Low serum Vitamin D levels are common in orthopedic patients in India. Low serum Vitamin D levels are implicated in COVID-19 worsening the illness. With this background, we assessed serum Vitamin D levels in COVID-19 patients presenting to us and correlated them with other markers of bone metabolism and systemic immune response. Materials and Methods: A cross-sectional analytical study was done on 107 COVID-19 patients. The sample was taken for serum calcium, serum Vitamin D, serum phosphate, bone-specific alkaline phosphatase (ALP), serum parathyroid hormone, creatine phosphokinase (CPK), CPK myocardial band (MB), serum protein, C-reactive protein, erythrocyte sedimentation rate, and hemoglobin in these patients. The levels were correlated with each other to assess their relations in COVID-19 patients. Results: One hundred out of 107 patients had low serum Vitamin D levels. In these patients, serum lactate dehydrogenase and serum ALP levels were high, and creatine kinase MB levels were low. The illness was found more in diabetic/hypertensive and rheumatoid arthritis patients. The values and findings correlate with increased disease activity and osteopenia with no obvious muscular injury. Conclusion: Managing Vitamin D deficiency (VDD) has been taken up as a major step in COVID-19 affection. The markers of bone metabolism and their correlation with serum Vitamin D were equivocal in COVID-19-affected and not affected Indian populations. The risk of infection has been more in diabetic, hypertensive, and rheumatoid arthritis patients, all of whom were also suffering from VDD.
{"title":"Correlation of Vitamin D levels with markers of bone metabolism in COVID-19 patients","authors":"A. Agrawal, A. Behera, E. Mohapatra, H. Sakale, Seema K Shah, Bikram Kar, M. Ojha, B. Nayak, A. Garg","doi":"10.4103/jotr.jotr_115_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_115_22","url":null,"abstract":"Introduction: Low serum Vitamin D levels are common in orthopedic patients in India. Low serum Vitamin D levels are implicated in COVID-19 worsening the illness. With this background, we assessed serum Vitamin D levels in COVID-19 patients presenting to us and correlated them with other markers of bone metabolism and systemic immune response. Materials and Methods: A cross-sectional analytical study was done on 107 COVID-19 patients. The sample was taken for serum calcium, serum Vitamin D, serum phosphate, bone-specific alkaline phosphatase (ALP), serum parathyroid hormone, creatine phosphokinase (CPK), CPK myocardial band (MB), serum protein, C-reactive protein, erythrocyte sedimentation rate, and hemoglobin in these patients. The levels were correlated with each other to assess their relations in COVID-19 patients. Results: One hundred out of 107 patients had low serum Vitamin D levels. In these patients, serum lactate dehydrogenase and serum ALP levels were high, and creatine kinase MB levels were low. The illness was found more in diabetic/hypertensive and rheumatoid arthritis patients. The values and findings correlate with increased disease activity and osteopenia with no obvious muscular injury. Conclusion: Managing Vitamin D deficiency (VDD) has been taken up as a major step in COVID-19 affection. The markers of bone metabolism and their correlation with serum Vitamin D were equivocal in COVID-19-affected and not affected Indian populations. The risk of infection has been more in diabetic, hypertensive, and rheumatoid arthritis patients, all of whom were also suffering from VDD.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"58 1","pages":"149 - 153"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82308844","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}
Hoffa fractures are distal coronal femoral fractures which are intra-articular and involve one or both of the condyles. The lateral condyle is three times more likely to sustain an injury than the medial condyle. Malunion is one of the late complications in neglected instances or following nonoperative management. Medial femoral condyle injuries are quite uncommon. In this case study, a 23-year-old male with a neglected medial Hoffa's malunion is discussed. The patient presented with pain, deformity, and restriction of movements in the left knee for 6 months. Pain aggravates walking and was affecting his daily activities. He allegedly had a past trauma 18 months back for which he took osteopathic treatment. On examination, fixed 10° varus knee deformity is noted, and there is a fixed flexion deformity of 10° with further flexion up to 100°, i.e., there is an extension block terminally. X-rays and computed tomography scan showed medial condyle Hoffa's malunion with obvious intra-articular step. Treatment aims to reduce the articular surface anatomically and provide rigid and stable fixation. Treatment's objectives included easing pain and addressing deformities and improving the range of movements and early mobilization. The patient was assessed clinically with a Knee Society Score. The primary method of treatment for Hoffa's malunion is surgical. Intra-articular osteotomy should be taken into consideration as a salvage option in the younger population to prevent arthritis. The use of an antiglide plate in conjunction with screws provides rigid and stable fixation.
{"title":"Intra-articular osteotomy for correction of neglected malunion of medial femoral condyle Hoffa's fracture","authors":"Prabhat Mittal, K. Shetty, MS Darshan","doi":"10.4103/jotr.jotr_94_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_94_22","url":null,"abstract":"Hoffa fractures are distal coronal femoral fractures which are intra-articular and involve one or both of the condyles. The lateral condyle is three times more likely to sustain an injury than the medial condyle. Malunion is one of the late complications in neglected instances or following nonoperative management. Medial femoral condyle injuries are quite uncommon. In this case study, a 23-year-old male with a neglected medial Hoffa's malunion is discussed. The patient presented with pain, deformity, and restriction of movements in the left knee for 6 months. Pain aggravates walking and was affecting his daily activities. He allegedly had a past trauma 18 months back for which he took osteopathic treatment. On examination, fixed 10° varus knee deformity is noted, and there is a fixed flexion deformity of 10° with further flexion up to 100°, i.e., there is an extension block terminally. X-rays and computed tomography scan showed medial condyle Hoffa's malunion with obvious intra-articular step. Treatment aims to reduce the articular surface anatomically and provide rigid and stable fixation. Treatment's objectives included easing pain and addressing deformities and improving the range of movements and early mobilization. The patient was assessed clinically with a Knee Society Score. The primary method of treatment for Hoffa's malunion is surgical. Intra-articular osteotomy should be taken into consideration as a salvage option in the younger population to prevent arthritis. The use of an antiglide plate in conjunction with screws provides rigid and stable fixation.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"35 1","pages":"168 - 171"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79159151","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}
A. Arya, K. Chandan, Pankaj Kumarverma, Santosh Kumar
Objective: The objective of the study to compare the relative effectiveness of intralesional steroid versus platelet-rich plasma (PRP) injection among 80 patients in plantar fasciitis. Materials and Methods: A total number of 80 patients with plantar fasciitis were divided into two groups. Group A with 30 patients received intralesional PRP and Group B received intralesional methylprednisolone acetate injection. Pre- and post-intervention visual analogue scale (VAS), the Foot and Ankle Ability Measure (FAAM) score, and Plantar Fascia (PF) thickness for the assessment of pain relief in two groups were recorded at 6 months. Results: The mean VAS scores for heel pain measured after 6 months of treatment were 1.460 ± 0.6911 in PRP group and 3.024 ± 0.9572 in steroid group. The decrease in mean VAS score in both the groups was statistically significant when compared with pretreatment values (8.38 ± 0.6820 in PRP group and 8.44 ± 0.6021 in steroid group). The mean FAAM score measured after 6 months of treatment increased in both the groups (83.43 ± 5.661 in PRP group and 69.12 ± 5.795 in steroid group) when compared with pretreatment value (29.97 ± 5.997 in PRP group and 31.68 ± 6.297 in steroid group), and it was statistically significant. There was 35.90% reduction in mean PF thickness in PRP group and 28.67% reduction in steroid group as compared to baseline values after 6 months of injection. Conclusion: Intralesional injections of both the PRP and steroid are effective and safe modalities of treatment for plantar fasciitis. A steroid is better for short-term treatment of plantar fasciitis, but in long-term follow-up, PRP therapy is better than steroid. Both the treatment methods have caused a significant reduction in PF thickness.
{"title":"“To compare the relative effectiveness of intralesional steroid versus platelet-rich plasma injection among 80 patients in plantar fasciitis: A prospective study”","authors":"A. Arya, K. Chandan, Pankaj Kumarverma, Santosh Kumar","doi":"10.4103/jotr.jotr_27_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_27_22","url":null,"abstract":"Objective: The objective of the study to compare the relative effectiveness of intralesional steroid versus platelet-rich plasma (PRP) injection among 80 patients in plantar fasciitis. Materials and Methods: A total number of 80 patients with plantar fasciitis were divided into two groups. Group A with 30 patients received intralesional PRP and Group B received intralesional methylprednisolone acetate injection. Pre- and post-intervention visual analogue scale (VAS), the Foot and Ankle Ability Measure (FAAM) score, and Plantar Fascia (PF) thickness for the assessment of pain relief in two groups were recorded at 6 months. Results: The mean VAS scores for heel pain measured after 6 months of treatment were 1.460 ± 0.6911 in PRP group and 3.024 ± 0.9572 in steroid group. The decrease in mean VAS score in both the groups was statistically significant when compared with pretreatment values (8.38 ± 0.6820 in PRP group and 8.44 ± 0.6021 in steroid group). The mean FAAM score measured after 6 months of treatment increased in both the groups (83.43 ± 5.661 in PRP group and 69.12 ± 5.795 in steroid group) when compared with pretreatment value (29.97 ± 5.997 in PRP group and 31.68 ± 6.297 in steroid group), and it was statistically significant. There was 35.90% reduction in mean PF thickness in PRP group and 28.67% reduction in steroid group as compared to baseline values after 6 months of injection. Conclusion: Intralesional injections of both the PRP and steroid are effective and safe modalities of treatment for plantar fasciitis. A steroid is better for short-term treatment of plantar fasciitis, but in long-term follow-up, PRP therapy is better than steroid. Both the treatment methods have caused a significant reduction in PF thickness.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"8 1","pages":"121 - 125"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80483988","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 : 2022-07-01DOI: 10.18231/j.ijpo.2022.060
V. Kakkar, Dheeraj Makkar
Rhabdomyosarcoma (RMS) is the most common soft sarcoma in kids, with alveolar and embryonal variants distinguishable by histopathology and, more significantly, molecular biology. RMS occurs intermittently in a substantial proportion of cases without a predisposing condition. Nevertheless, it is well established that certain hereditary factors enhance the likelihood of developing RMS. Beckwith–Wiedemann syndrome, Gorlin syndrome, Costello syndrome, neurofibromatosis type 1 (NF1), and Li-Fraumeni syndromes are some of them. These syndromes present with RMS during childhood. A 47-year-old female with NF1 discovered a lump in her right forearm 1 year before presentation. When the patient noticed ulceration on the swelling, she sought medical attention. A tumor was detected in the center of the right forearm through magnetic resonance imaging, and it was suspected to be a cystic or myxoid soft-tissue tumor, RMS, or a peripheral neural tumor. We classified the tumor as stage IV due to axillary lymph node involvement and lung metastasis. Histopathology confirmed RMS. The patient then received radiotherapy and chemotherapy, and her tumor went into remission. After confirming NF1 syndrome, we advise patients to adhere to the standard cancer screening protocol. The screening would assist in the earlier diagnosis of tumors, leading to a reduction in complications.
{"title":"Forearm rhabdomyosarcoma in neurofibromatosis type 1: A unique case","authors":"V. Kakkar, Dheeraj Makkar","doi":"10.18231/j.ijpo.2022.060","DOIUrl":"https://doi.org/10.18231/j.ijpo.2022.060","url":null,"abstract":"Rhabdomyosarcoma (RMS) is the most common soft sarcoma in kids, with alveolar and embryonal variants distinguishable by histopathology and, more significantly, molecular biology. RMS occurs intermittently in a substantial proportion of cases without a predisposing condition. Nevertheless, it is well established that certain hereditary factors enhance the likelihood of developing RMS. Beckwith–Wiedemann syndrome, Gorlin syndrome, Costello syndrome, neurofibromatosis type 1 (NF1), and Li-Fraumeni syndromes are some of them. These syndromes present with RMS during childhood. A 47-year-old female with NF1 discovered a lump in her right forearm 1 year before presentation. When the patient noticed ulceration on the swelling, she sought medical attention. A tumor was detected in the center of the right forearm through magnetic resonance imaging, and it was suspected to be a cystic or myxoid soft-tissue tumor, RMS, or a peripheral neural tumor. We classified the tumor as stage IV due to axillary lymph node involvement and lung metastasis. Histopathology confirmed RMS. The patient then received radiotherapy and chemotherapy, and her tumor went into remission. After confirming NF1 syndrome, we advise patients to adhere to the standard cancer screening protocol. The screening would assist in the earlier diagnosis of tumors, leading to a reduction in complications.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"23 1","pages":"172 - 175"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82057970","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 : 2022-07-01DOI: 10.4103/jotr.jotr_118_22
Nazneen Nazm, Lata Keshkar, Manju R. Agrawal, M. Akhtar, S. Keshkar, A. Agrawal
Background: Epidural steroid injection is a common intervention for symptomatic lumbar disc herniation. It is safe, but not absolutely free from complications. Visual complications and adverse intraocular events are sparse in the literature. This study is done to determine any intraocular complication after caudal epidural steroid injection for discogenic low back pain and radiculopathy. Materials and Methods: It was a prospective study, conducted from April 2018 to December 2019 by the orthopedics and ophthalmology departments of our institute. A total of 31 patients were recruited based on inclusion/exclusion criteria. All the patients presented to this institute with complaints of low back pain and sciatica were investigated. After proper diagnosis, the decision was made for caudal epidural steroid injection as per the standard principles of orthopedic surgery. Eye evaluations (intraocular pressure [IOP], visual acuity, and ocular examination) were done 1 day before, and 2–4 h, 1 week, and 2 weeks after epidural injection. The differences in eye evaluation values between time points were determined and discussed. Results: A total of 31 patients were recruited for this study, out of which the majority of the patients (27 patients) were between 41 and 60 years of age, and males (22 patients) outnumbered females (nine patients). Most of the patients (17 patients) had prolapsed IV disc of L5-S1. IOP was found to be raised after the intervention of epidural steroid injection which gradually came down to a preinjection level within 2 weeks. There was no change in visual acuity and no other intraocular complications, like hemorrhages. Conclusion: Epidural steroid injection for discogenic low backache (LBA) with radiculopathy did not adversely affect IOP, and neither had any ocular complication (in an ophthalmologically normal set of patients). A prudent approach should always be implemented.
{"title":"Intraocular complications after caudal epidural steroid injection for discogenic lumbar pain with radiculopathy","authors":"Nazneen Nazm, Lata Keshkar, Manju R. Agrawal, M. Akhtar, S. Keshkar, A. Agrawal","doi":"10.4103/jotr.jotr_118_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_118_22","url":null,"abstract":"Background: Epidural steroid injection is a common intervention for symptomatic lumbar disc herniation. It is safe, but not absolutely free from complications. Visual complications and adverse intraocular events are sparse in the literature. This study is done to determine any intraocular complication after caudal epidural steroid injection for discogenic low back pain and radiculopathy. Materials and Methods: It was a prospective study, conducted from April 2018 to December 2019 by the orthopedics and ophthalmology departments of our institute. A total of 31 patients were recruited based on inclusion/exclusion criteria. All the patients presented to this institute with complaints of low back pain and sciatica were investigated. After proper diagnosis, the decision was made for caudal epidural steroid injection as per the standard principles of orthopedic surgery. Eye evaluations (intraocular pressure [IOP], visual acuity, and ocular examination) were done 1 day before, and 2–4 h, 1 week, and 2 weeks after epidural injection. The differences in eye evaluation values between time points were determined and discussed. Results: A total of 31 patients were recruited for this study, out of which the majority of the patients (27 patients) were between 41 and 60 years of age, and males (22 patients) outnumbered females (nine patients). Most of the patients (17 patients) had prolapsed IV disc of L5-S1. IOP was found to be raised after the intervention of epidural steroid injection which gradually came down to a preinjection level within 2 weeks. There was no change in visual acuity and no other intraocular complications, like hemorrhages. Conclusion: Epidural steroid injection for discogenic low backache (LBA) with radiculopathy did not adversely affect IOP, and neither had any ocular complication (in an ophthalmologically normal set of patients). A prudent approach should always be implemented.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"4 1","pages":"160 - 162"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90171640","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 : 2022-07-01DOI: 10.4103/jotr.jotr_108_21
Santhosh Kumar, Vikas Kulshrestha, M. Sood, B. Datta, G. Mittal
Objective: Prosthetic joint dislocation remains a significant cause of revision following total hip replacement (THR). To prevent this complication, emphasis has been on choosing the optimum surgical approach, accurate implant alignment, bigger femoral head size, and implementing postoperative hip precautions. In the last decade, a newer acetabular design concept; the “Dual Mobility cup” (DM cup) was introduced to reduce the prosthetic dislocation. Although the concept of the use of such a device is well accepted, there remains apprehension regarding its precise indications, the outcome in terms of wear and ability to decrease the incidence of prosthetic dislocation. We reviewed the early results of a particular DM cup design. Materials and Methods: This study shares a single center experience of using a monoblock DM cup (Captiv DM, Evolutis, Briennon, France) in THR. It is a prospective cohort study that looked at indications, handling issues, complications including prosthetic dislocations at 24 months follow-up. Results: We followed up results of uncemented and cemented DM cup used in 129 patients who underwent primary THR or revision THR (RTHR). There was one (1.6%) prosthetic dislocation amongst primary THR and 2 (3%) in the RTHR group. There were handling issues with monoblock uncemented DM cups of occasional improper seating and acetabular rim fracture. Three cases in which revision was performed, were due to component to component impingement and resulted due to inappropriate acetabular version. Conclusion: The use of DM cups while performing THR or RTHR significantly decreased the incidence of instability. While placing DM cups an attempt should be made to maintain the native version of the acetabular cup to decrease the risk of component impingement and instability. Level of Evidence: Level III, therapeutic study.
{"title":"Dual mobility cup in total hip replacements: a single center experience","authors":"Santhosh Kumar, Vikas Kulshrestha, M. Sood, B. Datta, G. Mittal","doi":"10.4103/jotr.jotr_108_21","DOIUrl":"https://doi.org/10.4103/jotr.jotr_108_21","url":null,"abstract":"Objective: Prosthetic joint dislocation remains a significant cause of revision following total hip replacement (THR). To prevent this complication, emphasis has been on choosing the optimum surgical approach, accurate implant alignment, bigger femoral head size, and implementing postoperative hip precautions. In the last decade, a newer acetabular design concept; the “Dual Mobility cup” (DM cup) was introduced to reduce the prosthetic dislocation. Although the concept of the use of such a device is well accepted, there remains apprehension regarding its precise indications, the outcome in terms of wear and ability to decrease the incidence of prosthetic dislocation. We reviewed the early results of a particular DM cup design. Materials and Methods: This study shares a single center experience of using a monoblock DM cup (Captiv DM, Evolutis, Briennon, France) in THR. It is a prospective cohort study that looked at indications, handling issues, complications including prosthetic dislocations at 24 months follow-up. Results: We followed up results of uncemented and cemented DM cup used in 129 patients who underwent primary THR or revision THR (RTHR). There was one (1.6%) prosthetic dislocation amongst primary THR and 2 (3%) in the RTHR group. There were handling issues with monoblock uncemented DM cups of occasional improper seating and acetabular rim fracture. Three cases in which revision was performed, were due to component to component impingement and resulted due to inappropriate acetabular version. Conclusion: The use of DM cups while performing THR or RTHR significantly decreased the incidence of instability. While placing DM cups an attempt should be made to maintain the native version of the acetabular cup to decrease the risk of component impingement and instability. Level of Evidence: Level III, therapeutic study.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"73 1","pages":"126 - 133"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80455937","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: More recent advances are about the incision technique for intramedullary interlocking (IMIL) nailing, a 3 cm stab incision is sufficient for the procedure of IMIL nailing as compared to commonly used suprapatellar incision of 5–7 cm with splitting of patellar tendon which might result in chronic knee pain restricted range of movement, risk of infection, longer duration of postoperative rehabilitation, and poor wound healing. Objective: A retrospective study and analysis of three stitch technique in posttraumatic shaft tibia fractures to assess the range of motion. Background: Tibial shaft fractures have peaked in incidence in the past decade with sky rocketing amount of road traffic accidents. With the mainstay of making any patient of such traumatic incident being early mobilisation, IMIL nailing for tibia remains one of the finest treatment modalities among plating or external fixator applications. With the increased demands in the field of cosmetology and minimally invasive scar techniques, the 3-stitch technique would have a major impact not only on the early healing of surgical scar but also reduced chances of acquired infections along with advancements in weight-bearing exercises. Materials and Methods: A retrospective analysis of midshaft tibia fractures who were treated with IMIL nailing with 3-stitch technique with a sample size of post op 100 patients. A study was held at a tertiary care hospital and research center. Results: Sample size of postoperative 100 patients out of which 76 showed conclusive results and 24 were lost at follow-up. Conclusion: Good to excellent outcome with a small healed scar was observed in patients who underwent 3-stitch technique IMIL nailing for shaft tibia fractures.
{"title":"An innovative three stitch technique in tibia interlocking nailing a retrospective analysis","authors":"R. Butala, Maitreya Patil, P. Samant, K. Parelkar","doi":"10.4103/jotr.jotr_21_21","DOIUrl":"https://doi.org/10.4103/jotr.jotr_21_21","url":null,"abstract":"Introduction: More recent advances are about the incision technique for intramedullary interlocking (IMIL) nailing, a 3 cm stab incision is sufficient for the procedure of IMIL nailing as compared to commonly used suprapatellar incision of 5–7 cm with splitting of patellar tendon which might result in chronic knee pain restricted range of movement, risk of infection, longer duration of postoperative rehabilitation, and poor wound healing. Objective: A retrospective study and analysis of three stitch technique in posttraumatic shaft tibia fractures to assess the range of motion. Background: Tibial shaft fractures have peaked in incidence in the past decade with sky rocketing amount of road traffic accidents. With the mainstay of making any patient of such traumatic incident being early mobilisation, IMIL nailing for tibia remains one of the finest treatment modalities among plating or external fixator applications. With the increased demands in the field of cosmetology and minimally invasive scar techniques, the 3-stitch technique would have a major impact not only on the early healing of surgical scar but also reduced chances of acquired infections along with advancements in weight-bearing exercises. Materials and Methods: A retrospective analysis of midshaft tibia fractures who were treated with IMIL nailing with 3-stitch technique with a sample size of post op 100 patients. A study was held at a tertiary care hospital and research center. Results: Sample size of postoperative 100 patients out of which 76 showed conclusive results and 24 were lost at follow-up. Conclusion: Good to excellent outcome with a small healed scar was observed in patients who underwent 3-stitch technique IMIL nailing for shaft tibia fractures.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"5 1","pages":"134 - 143"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88093401","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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