Background: Treatment alternatives for patella fractures with the inferior pole are still being deliberated. In addition to tension-band wiring, metal implant-related complications are also not uncommon to occur in patellar fracture treatment. It is common to encounter implant-related complications such as implants failing, palpable hardware which require supplementary techniques to resolve. We evaluated participants with inferior poles of patella fracture treated with transosseous nonabsorbable sutures on functional outcomes. Methodology: This study encompasses observation of patients having transosseous suture fixation by no. 5 Ethibond for fixation of distal pole patella fractures. This was a longitudinal study piloted at a tertiary care center between January 2020 and June 2022. Patients' functional outcomes were assessed using the Bostman score. Results: The Bostman scoring system was used to evaluate the outcome at the final follow-up. In 19 patients, 7 (36.84%) patients showed outstanding and 11 (57.89%) patients showed good outcomes at the termination of 9 months follow-up. Only one patient established an unsatisfactory result. Conclusion: Distal pole patella fractures can be effectively fixed via transosseous suturing with unabsorbable sutures. Fast recovery and minimal implant-related complications are possible with this procedure. The resurgery rate is also significantly reduced.
{"title":"Nonabsorbable transosseous sutures for lower pole patella fractures: An effective surgical technique to prevent implant complications","authors":"Sanjeev Jaiswal, U. Wankhade, Sagar Kharat, Mahendra Gudhe, Sumit Tarekar, Akash Bhakare","doi":"10.4103/jotr.jotr_96_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_96_22","url":null,"abstract":"Background: Treatment alternatives for patella fractures with the inferior pole are still being deliberated. In addition to tension-band wiring, metal implant-related complications are also not uncommon to occur in patellar fracture treatment. It is common to encounter implant-related complications such as implants failing, palpable hardware which require supplementary techniques to resolve. We evaluated participants with inferior poles of patella fracture treated with transosseous nonabsorbable sutures on functional outcomes. Methodology: This study encompasses observation of patients having transosseous suture fixation by no. 5 Ethibond for fixation of distal pole patella fractures. This was a longitudinal study piloted at a tertiary care center between January 2020 and June 2022. Patients' functional outcomes were assessed using the Bostman score. Results: The Bostman scoring system was used to evaluate the outcome at the final follow-up. In 19 patients, 7 (36.84%) patients showed outstanding and 11 (57.89%) patients showed good outcomes at the termination of 9 months follow-up. Only one patient established an unsatisfactory result. Conclusion: Distal pole patella fractures can be effectively fixed via transosseous suturing with unabsorbable sutures. Fast recovery and minimal implant-related complications are possible with this procedure. The resurgery rate is also significantly reduced.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"42 1","pages":"163 - 167"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90781364","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: The growing trend toward the use of pedicle screws for the operative treatment of patients with idiopathic scoliosis is to provide a three-dimensional (3D) deformity correction using a three-column fixation was observed. Reports have variable recommendations regarding the implant density as well as the configuration of the pedicle screws. This study re-evaluated implant density and curve correction currently based on the 3D correction strategy by comparing it to side-bending correction (SBC). Materials and Methods: Seventy-six adolescent idiopathic scoliosis (AIS) patients who had undergone posterior spinal fusion from 2017 to 2019 visited our specialized center were recruited. Demographic variables and radiological measurements were collected. Patients filled out the Scoliosis Research Society (SRS-22) questionnaire from a mobile device, of which the SRS-22 was digitally adopted using mobile technology and cloud computation. Results: In the 76 AIS patients, 28 (37%) were rigid curves and 48 (63%) were flexible curves. Of the 28 rigid curves (SBC <30%), 13 (46%) patients had low pedicle screw density (PSD), while 15 (54%) had high PSD. Of the 48 flexible curves, 26 (55%) patients had low PSD, while 22 (45%) patients had high PSD. SBC index for the high PSD group (172) is almost the same compared to the low PSD group (174). Conclusions: Using high or low PSD makes the same amount of spinal correction for this group and additional screws do not make significant improvement on spinal correction. Higher screw density instrumentation is associated with the same amount of correction rate, whether in rigid or flexible curves, leading us to postulate that scoliosis correction relates more to intrinsic curve flexibility rather than instrument density.
{"title":"Implant density and curve correction in scoliosis surgery using a three-dimensional-based correction strategy","authors":"B. Ng, Victor Illescas, W. Chau","doi":"10.4103/jotr.jotr_6_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_6_22","url":null,"abstract":"Introduction: The growing trend toward the use of pedicle screws for the operative treatment of patients with idiopathic scoliosis is to provide a three-dimensional (3D) deformity correction using a three-column fixation was observed. Reports have variable recommendations regarding the implant density as well as the configuration of the pedicle screws. This study re-evaluated implant density and curve correction currently based on the 3D correction strategy by comparing it to side-bending correction (SBC). Materials and Methods: Seventy-six adolescent idiopathic scoliosis (AIS) patients who had undergone posterior spinal fusion from 2017 to 2019 visited our specialized center were recruited. Demographic variables and radiological measurements were collected. Patients filled out the Scoliosis Research Society (SRS-22) questionnaire from a mobile device, of which the SRS-22 was digitally adopted using mobile technology and cloud computation. Results: In the 76 AIS patients, 28 (37%) were rigid curves and 48 (63%) were flexible curves. Of the 28 rigid curves (SBC <30%), 13 (46%) patients had low pedicle screw density (PSD), while 15 (54%) had high PSD. Of the 48 flexible curves, 26 (55%) patients had low PSD, while 22 (45%) patients had high PSD. SBC index for the high PSD group (172) is almost the same compared to the low PSD group (174). Conclusions: Using high or low PSD makes the same amount of spinal correction for this group and additional screws do not make significant improvement on spinal correction. Higher screw density instrumentation is associated with the same amount of correction rate, whether in rigid or flexible curves, leading us to postulate that scoliosis correction relates more to intrinsic curve flexibility rather than instrument density.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"96 1","pages":"115 - 120"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75652713","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: Trauma is globally associated with significant mortality with developing countries bearing a disproportionately high burden. It represents a major epidemic of non – communicable disease. The aim of this study is to evaluate the incidence of various fracture and dislocation patterns in patients with extremity injuries and their 1- year mortality rate. Materials and Methods: An observational, prospective study was undertaken to analyse the incidence of fracture and dislocation patterns in patients coming to the Orthopaedics OPD and emergency medicine department in a tertiary hospital during a period of two years from 1st, October 2017 to 30th, September 2019. Overall, 1182 patients were enrolled for the study with a mean age of 43 yrs. Results: Age group 21 – 30 years was most common (17.1%) age to suffer injuries with a male preponderance (67.5%). The most common mode of injury was by road traffic accident (43%). 97.9% of the injuries had unilateral involvement with the lower extremity (57.2%) and the femur (21.2%) being most frequently fractured. Dislocations/fracture-dislocations constituted only 5.5% cases with shoulder dislocation being the most frequently involved joint. Plain radiographs were used in 96.9% cases for final diagnosis. Forty cases (3.4%) were found to not survive in the 1-year follow up after fracture. Conclusion: The present study shows that most of the causes of trauma are preventable. This study could assist in raising the profile of RTI as a public health problem which needs to be addressed as a preventable cause of mortality and morbidity, and planning appropriate interventions for this major challenge.
{"title":"Incidence of fracture and dislocation patterns in patients with extremity injuries reporting to a tertiary care hospital","authors":"M. Khadilkar, Anish Tawde, Gopal T. Pundkare","doi":"10.4103/jotr.jotr_63_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_63_22","url":null,"abstract":"Background: Trauma is globally associated with significant mortality with developing countries bearing a disproportionately high burden. It represents a major epidemic of non – communicable disease. The aim of this study is to evaluate the incidence of various fracture and dislocation patterns in patients with extremity injuries and their 1- year mortality rate. Materials and Methods: An observational, prospective study was undertaken to analyse the incidence of fracture and dislocation patterns in patients coming to the Orthopaedics OPD and emergency medicine department in a tertiary hospital during a period of two years from 1st, October 2017 to 30th, September 2019. Overall, 1182 patients were enrolled for the study with a mean age of 43 yrs. Results: Age group 21 – 30 years was most common (17.1%) age to suffer injuries with a male preponderance (67.5%). The most common mode of injury was by road traffic accident (43%). 97.9% of the injuries had unilateral involvement with the lower extremity (57.2%) and the femur (21.2%) being most frequently fractured. Dislocations/fracture-dislocations constituted only 5.5% cases with shoulder dislocation being the most frequently involved joint. Plain radiographs were used in 96.9% cases for final diagnosis. Forty cases (3.4%) were found to not survive in the 1-year follow up after fracture. Conclusion: The present study shows that most of the causes of trauma are preventable. This study could assist in raising the profile of RTI as a public health problem which needs to be addressed as a preventable cause of mortality and morbidity, and planning appropriate interventions for this major challenge.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"118 1","pages":"109 - 114"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79771930","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_111_22
H. Sakale, A. Agrawal, Martha Balakrishna, B. Kar, B. Moti
Introduction: The anterior cruciate ligament (ACL) has an important role in preserving the function and stability of the knee joint, and it prevents anterior translation of the tibia. The ACL is the most commonly injured structure of the knee following posttraumatic and sports-related injuries. The treatment of modality for ACL insufficiency was arthroscopic ACL reconstruction. In this study, we followed the transportal approach for ACL reconstruction using a Quadrupled Hamstring graft, and we reported the functional outcome of ACL reconstruction at a minimum follow-up of 6 months. Materials and Methods: This was a prospective outcome study conducted on 32 patients who met the inclusion and exclusion criteria. All patients in this study underwent arthroscopic reconstruction of ACL using quadrupled hamstring tendon graft through transportal technique. The graft was fixed with an endobutton on the femoral side and an interference screw on the tibial side. Patients were assessed for the functional outcome for a minimum of 6 months using the Tegner-Lysholm knee scoring system. Results: The mean age of the patient was 27 years. The majority of involved patients were males. The left side (77.14%) was involved more than the right side (22.86%). The most common cause of ACL injury in this study was road traffic accidents. Preoperative Tegner-Lysholm scores were 20 (62.5%) patients had poor and 12 (37.5%) patients had fair scores. Post-operatively, at 6 months follow-up, 27 patients had excellent, four patients had good scores, and one patient had a fair score. There was a significant improvement in the Tenger-Lysholm scoring system after 6 months of follow-up when compared to preoperatively. Three patients had knee pain and thigh muscle wasting (2 – 3 cm) during follow-up. Conclusions: Transportal arthroscopic ACL reconstruction using Quadrupled Hamstring graft gives excellent functional outcome and knee kinematics.
{"title":"Evaluation of functional outcome following transportal arthroscopic anterior cruciate ligament reconstruction using quadrupled hamstring graft","authors":"H. Sakale, A. Agrawal, Martha Balakrishna, B. Kar, B. Moti","doi":"10.4103/jotr.jotr_111_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_111_22","url":null,"abstract":"Introduction: The anterior cruciate ligament (ACL) has an important role in preserving the function and stability of the knee joint, and it prevents anterior translation of the tibia. The ACL is the most commonly injured structure of the knee following posttraumatic and sports-related injuries. The treatment of modality for ACL insufficiency was arthroscopic ACL reconstruction. In this study, we followed the transportal approach for ACL reconstruction using a Quadrupled Hamstring graft, and we reported the functional outcome of ACL reconstruction at a minimum follow-up of 6 months. Materials and Methods: This was a prospective outcome study conducted on 32 patients who met the inclusion and exclusion criteria. All patients in this study underwent arthroscopic reconstruction of ACL using quadrupled hamstring tendon graft through transportal technique. The graft was fixed with an endobutton on the femoral side and an interference screw on the tibial side. Patients were assessed for the functional outcome for a minimum of 6 months using the Tegner-Lysholm knee scoring system. Results: The mean age of the patient was 27 years. The majority of involved patients were males. The left side (77.14%) was involved more than the right side (22.86%). The most common cause of ACL injury in this study was road traffic accidents. Preoperative Tegner-Lysholm scores were 20 (62.5%) patients had poor and 12 (37.5%) patients had fair scores. Post-operatively, at 6 months follow-up, 27 patients had excellent, four patients had good scores, and one patient had a fair score. There was a significant improvement in the Tenger-Lysholm scoring system after 6 months of follow-up when compared to preoperatively. Three patients had knee pain and thigh muscle wasting (2 – 3 cm) during follow-up. Conclusions: Transportal arthroscopic ACL reconstruction using Quadrupled Hamstring graft gives excellent functional outcome and knee kinematics.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"13 1","pages":"154 - 159"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88454693","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}
Suryamanikanta Balabadra, Ratnakar Vecham, M. Reddy, Adarsh Annapareddy, M. Kumar, A. Reddy
Background: The success and survivorship of primary total knee replacement mainly depend on the postoperative alignment and implant position. Long-leg radiograph (LLR) is considered gold standard in assessing knee alignment postoperatively. Studies have reported that bowing of the femoral shaft in the coronal plane is prevalent in Asian population, which is not fully visualized on a conventional knee radiograph (CKR) and may affect the assessment of coronal alignment. However, postoperatively, CKR is easy to perform and has several advantages if it provides similar precision. Purpose: The purpose was to evaluate the validity of CKR in assessing the anatomical knee alignment and prosthesis position as compared with the LLR in Indian population. Materials and Methods: One hundred knees in 83 patients were subjected to CKR and LLR during postoperative follow-up at 6 weeks. Three parameters were evaluated to assess the coronal alignment and the component positions - femoral component angle (FCA), tibial component angle (TCA), and tibiofemoral angle (TFA). Results: There was an excellent correlation between the TCA as measured from the long and CKRs (r = 0.884, P = 0.01). There was a high positive correlation between the FCA (r = 0.703, P = 0.01) and TFA (r = 0.754, P = 0.01) as measured from the long radiographs and the conventional radiographs. Regression analysis defined these relationships to be linear. Conclusion: CKR could be an appropriate alternative for the LLR in evaluating the postoperative knee alignment and total knee prosthesis position despite the fact that there is excessive femoral bowing in Indian population.
背景:原发性全膝关节置换术的成功和存活主要取决于术后假体的排列和位置。长腿x线片(LLR)被认为是评估术后膝关节对齐的金标准。有研究报道，在亚洲人群中，股骨干的冠状面弯曲很普遍，这在传统的膝关节x线片(CKR)上不能完全显示，并可能影响冠状面对齐的评估。然而，术后，CKR很容易执行，如果它提供类似的精度，它有几个优点。目的:目的是评估CKR与LLR在印度人群中评估膝关节解剖线和假体位置的有效性。材料与方法:83例患者100个膝关节在术后6周随访期间进行CKR和LLR。评估冠状面对齐和假体位置的三个参数:股骨假体角(FCA)、胫骨假体角(TCA)和胫股角(TFA)。结果:长径测得的TCA与ckr有极好的相关性(r = 0.884, P = 0.01)。长片和常规x线片FCA与TFA呈高度正相关(r = 0.703, P = 0.01)，两者呈正相关(r = 0.754, P = 0.01)。回归分析将这些关系定义为线性关系。结论:尽管印度人群中存在过度的股骨弯曲，但CKR可以作为LLR评估术后膝关节对齐和全膝关节假体位置的合适替代方法。
{"title":"Is conventional knee radiograph reliable enough to assess the anatomical knee alignment and total knee prosthesis position in Indian population?","authors":"Suryamanikanta Balabadra, Ratnakar Vecham, M. Reddy, Adarsh Annapareddy, M. Kumar, A. Reddy","doi":"10.4103/jotr.jotr_59_21","DOIUrl":"https://doi.org/10.4103/jotr.jotr_59_21","url":null,"abstract":"Background: The success and survivorship of primary total knee replacement mainly depend on the postoperative alignment and implant position. Long-leg radiograph (LLR) is considered gold standard in assessing knee alignment postoperatively. Studies have reported that bowing of the femoral shaft in the coronal plane is prevalent in Asian population, which is not fully visualized on a conventional knee radiograph (CKR) and may affect the assessment of coronal alignment. However, postoperatively, CKR is easy to perform and has several advantages if it provides similar precision. Purpose: The purpose was to evaluate the validity of CKR in assessing the anatomical knee alignment and prosthesis position as compared with the LLR in Indian population. Materials and Methods: One hundred knees in 83 patients were subjected to CKR and LLR during postoperative follow-up at 6 weeks. Three parameters were evaluated to assess the coronal alignment and the component positions - femoral component angle (FCA), tibial component angle (TCA), and tibiofemoral angle (TFA). Results: There was an excellent correlation between the TCA as measured from the long and CKRs (r = 0.884, P = 0.01). There was a high positive correlation between the FCA (r = 0.703, P = 0.01) and TFA (r = 0.754, P = 0.01) as measured from the long radiographs and the conventional radiographs. Regression analysis defined these relationships to be linear. Conclusion: CKR could be an appropriate alternative for the LLR in evaluating the postoperative knee alignment and total knee prosthesis position despite the fact that there is excessive femoral bowing in Indian population.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"51 35","pages":"42 - 45"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72390438","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}
It is essential to consider melorheostosis in the differential diagnosis for patients presenting with soft-tissue swelling, joint contractures, and “dripping candle wax” like hyperostotic lesions on X-rays. Melorheostosis is a sporadic disease with an uncertain etiology. It is often diagnosed incidentally and can affect the bones of the vertebrae, trunk, and upper and lower extremities. It can present with compressive symptoms due to soft-tissue swelling and fibrosis. On the hand, symptoms of median nerve compression or trigger finger may occur. The treatment of this condition is primarily conservative, and surgery is reserved for patients with severe and disabling symptoms.
{"title":"Dripping candle wax lesion of the hand","authors":"L. Alexander","doi":"10.4103/jotr.jotr_30_21","DOIUrl":"https://doi.org/10.4103/jotr.jotr_30_21","url":null,"abstract":"It is essential to consider melorheostosis in the differential diagnosis for patients presenting with soft-tissue swelling, joint contractures, and “dripping candle wax” like hyperostotic lesions on X-rays. Melorheostosis is a sporadic disease with an uncertain etiology. It is often diagnosed incidentally and can affect the bones of the vertebrae, trunk, and upper and lower extremities. It can present with compressive symptoms due to soft-tissue swelling and fibrosis. On the hand, symptoms of median nerve compression or trigger finger may occur. The treatment of this condition is primarily conservative, and surgery is reserved for patients with severe and disabling symptoms.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"10 1","pages":"102 - 104"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74825839","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}
Acute limb ischemia in the neonatal period is a rarely reported complication of prematurity and needs a high index of suspicion for early diagnosis and a multidisciplinary approach for its management. Here, we present a case of a preterm baby that developed unilateral upper limb ischemia in the neonatal period and discussed the problems faced in the management of such cases. A 24-day-old male baby was referred to the orthopedics department because of bluish-black discoloration of the right hand and forearm and no active movement in the wrist and hand. The baby was preterm, delivered at 29 weeks of gestation lower-segment cesarean section with a birth weight of 900 g to a healthy mother with no preexisting illness. Although the line of demarcation was just below the elbow joint and conventional wisdom would dictate us to go for a transhumeral amputation, we opted for a below elbow amputation in a bid to save the elbow joint as we could have revised the amputation at a later date if needed. Neonatal acute limb ischemia has been rarely reported and needs a high index of suspicion. Preterm and low birth weight babies are more prone to it. Treatment of such patients depends on the cause of gangrene. Amputation at such young age is psychologically disturbing for the parents. However, it is usually associated with good functional outcomes as the child has not yet learned the use of a limb or developed cortical plasticity in the brain. All attempts should be made to preserve as much joint and physis as possible to have a functional joint with better prosthetic fitting.
{"title":"Unilateral upper extremity ischemia in a neonate – A rare complication of prematurity","authors":"A. Agrawal, R. Iyer, H. Sakale, A. Garg","doi":"10.4103/jotr.jotr_29_22","DOIUrl":"https://doi.org/10.4103/jotr.jotr_29_22","url":null,"abstract":"Acute limb ischemia in the neonatal period is a rarely reported complication of prematurity and needs a high index of suspicion for early diagnosis and a multidisciplinary approach for its management. Here, we present a case of a preterm baby that developed unilateral upper limb ischemia in the neonatal period and discussed the problems faced in the management of such cases. A 24-day-old male baby was referred to the orthopedics department because of bluish-black discoloration of the right hand and forearm and no active movement in the wrist and hand. The baby was preterm, delivered at 29 weeks of gestation lower-segment cesarean section with a birth weight of 900 g to a healthy mother with no preexisting illness. Although the line of demarcation was just below the elbow joint and conventional wisdom would dictate us to go for a transhumeral amputation, we opted for a below elbow amputation in a bid to save the elbow joint as we could have revised the amputation at a later date if needed. Neonatal acute limb ischemia has been rarely reported and needs a high index of suspicion. Preterm and low birth weight babies are more prone to it. Treatment of such patients depends on the cause of gangrene. Amputation at such young age is psychologically disturbing for the parents. However, it is usually associated with good functional outcomes as the child has not yet learned the use of a limb or developed cortical plasticity in the brain. All attempts should be made to preserve as much joint and physis as possible to have a functional joint with better prosthetic fitting.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"22 1","pages":"105 - 107"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79163738","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 : 2022-01-01DOI: 10.4103/jotr.jotr_100_21
A. Sharma, Nayyar Ali, Umesh Vyas, A. Bohra, ShivBhagwan Sharma
Background: Controversy still exists regarding the current treatment modalities for unstable distal radius fractures. A prospective study was performed to evaluate efficacy of bicolumnar plating (radial buttress and volar plating) technique, which is designed to providing sufficiently secure fixation treatment of distal radius fractures. Materials and Methods: The prospective randomized study was done under the department of orthopedics at SRG hospital Jhalawar. We operated 20 patients, with distal end radius fracture of type 23C2 and 23C3 with radial column fracture using bicolumnar plating between May 2019 to MAY 2021. All patients presented for follow-up till union. Patients belonged to age group 20-75 years with the mean age of 45 years. Twelve patients were male and eight were female. The duration of follow-up was 12-18 months. Results: Bicolumnar plating led to complete union of unstable distal radius fractures without additional procedures. The assessment of post-operative functional outcome was done using the MODIFIED MAYO WRIST SCORE. At the final follow-up, 15 patients had excellent score, 3 had good score and 2 had fair score. Conclusions: Bicolumnar plating is feasible option for the management of displaced distal radius fractures and can result in favorable surgical outcomes.
{"title":"Management of unstable fractures of the distal end radius using bicolumnar radius plating","authors":"A. Sharma, Nayyar Ali, Umesh Vyas, A. Bohra, ShivBhagwan Sharma","doi":"10.4103/jotr.jotr_100_21","DOIUrl":"https://doi.org/10.4103/jotr.jotr_100_21","url":null,"abstract":"Background: Controversy still exists regarding the current treatment modalities for unstable distal radius fractures. A prospective study was performed to evaluate efficacy of bicolumnar plating (radial buttress and volar plating) technique, which is designed to providing sufficiently secure fixation treatment of distal radius fractures. Materials and Methods: The prospective randomized study was done under the department of orthopedics at SRG hospital Jhalawar. We operated 20 patients, with distal end radius fracture of type 23C2 and 23C3 with radial column fracture using bicolumnar plating between May 2019 to MAY 2021. All patients presented for follow-up till union. Patients belonged to age group 20-75 years with the mean age of 45 years. Twelve patients were male and eight were female. The duration of follow-up was 12-18 months. Results: Bicolumnar plating led to complete union of unstable distal radius fractures without additional procedures. The assessment of post-operative functional outcome was done using the MODIFIED MAYO WRIST SCORE. At the final follow-up, 15 patients had excellent score, 3 had good score and 2 had fair score. Conclusions: Bicolumnar plating is feasible option for the management of displaced distal radius fractures and can result in favorable surgical outcomes.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"26 1","pages":"32 - 37"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84689256","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}
Raskesh Malhotra, Siddhartha Gupta, Amit Kumar Srivastava, R. Arora, Aditya Aggarwal, P. Mishra
Background: There is little information regarding inter- and intra-observer variation when classifying tibial plateau fractures using Schatzker classification system. There is paucity of literature regarding morphological characteristics of each Schatzker subtype on computerized tomography. Materials and Methods: Fifty-three patients (age 18–70 years) of either sex with fresh (<3 weeks old), closed tibial plateau fracture were included after obtaining their informed consent. Patients with previous surgery around tibia or knee and the ones with pathological fractures were excluded from the study. Standard plain radiographs (anterior, posterior, and lateral views) and an additional noncontrast computed tomography (CT) scan (with three-dimensional reconstruction) of knee and leg of the affected side were done. Five different surgeons classified these fractures as per Schatzker classification on two separate occasions. The intra- and inter-observer variations were calculated using the kappa test of Cohen. Additional morphological characteristics were also evaluated on CT scan. Results: The mean kappa values for five observers (A to E) for inter-observer agreement on Schatzker classification were 0.41 (moderate). The mean kappa value for intra-observer agreement was 0.71 (substantial). Six morphological characteristics were defined on CT scan-lateral condylar impaction (79.2%), tibial tuberosity fracture (3.8%), coronal plane (3.8%), tibial spine avulsion (22.6%), medial condylar impaction (17%), and posteromedial shear fracture (7.5%). Conclusion: There is inter- and intra-observer variation in Schatzker classification of tibial plateau fracture. The intra-observer variation (kappa 0.71) was found to be greater than the inter-observer variation (kappa 0.41). The additional morphological characteristics of tibial plateau fractures are better evaluated on CT scan. The articular depression, splits, and fracture geometry are better delineated on a CT scan than on plain X-rays alone.
{"title":"Inter- and intra-observer variation of schatzker classification of tibial plateau fractures and morphological characteristics of each fracture subtype on computed tomography scan","authors":"Raskesh Malhotra, Siddhartha Gupta, Amit Kumar Srivastava, R. Arora, Aditya Aggarwal, P. Mishra","doi":"10.4103/jotr.jotr_71_21","DOIUrl":"https://doi.org/10.4103/jotr.jotr_71_21","url":null,"abstract":"Background: There is little information regarding inter- and intra-observer variation when classifying tibial plateau fractures using Schatzker classification system. There is paucity of literature regarding morphological characteristics of each Schatzker subtype on computerized tomography. Materials and Methods: Fifty-three patients (age 18–70 years) of either sex with fresh (<3 weeks old), closed tibial plateau fracture were included after obtaining their informed consent. Patients with previous surgery around tibia or knee and the ones with pathological fractures were excluded from the study. Standard plain radiographs (anterior, posterior, and lateral views) and an additional noncontrast computed tomography (CT) scan (with three-dimensional reconstruction) of knee and leg of the affected side were done. Five different surgeons classified these fractures as per Schatzker classification on two separate occasions. The intra- and inter-observer variations were calculated using the kappa test of Cohen. Additional morphological characteristics were also evaluated on CT scan. Results: The mean kappa values for five observers (A to E) for inter-observer agreement on Schatzker classification were 0.41 (moderate). The mean kappa value for intra-observer agreement was 0.71 (substantial). Six morphological characteristics were defined on CT scan-lateral condylar impaction (79.2%), tibial tuberosity fracture (3.8%), coronal plane (3.8%), tibial spine avulsion (22.6%), medial condylar impaction (17%), and posteromedial shear fracture (7.5%). Conclusion: There is inter- and intra-observer variation in Schatzker classification of tibial plateau fracture. The intra-observer variation (kappa 0.71) was found to be greater than the inter-observer variation (kappa 0.41). The additional morphological characteristics of tibial plateau fractures are better evaluated on CT scan. The articular depression, splits, and fracture geometry are better delineated on a CT scan than on plain X-rays alone.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"9 2 1","pages":"18 - 23"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91156046","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: Valgisation high tibial osteotomy (HTO) is a widely performed procedure for patients with medial compartment unicompartmental osteoarthrosis knee with varus malalignment of lower limbs. Over the last two decades, medial open-wedge HTO has been more popular than lateral closed-wedge techniques due to multiple advantages. Recently, isolated proximal fibular osteotomy/fibulectomy (PFO) has been advocated as a treatment for medial tibiofemoral osteoarthrosis in young patients. The role of fibulectomy as an adjunct to medial open-wedge HTO has been scarcely reviewed in the literature. Materials and Methods: This study is a retrospective comparative evaluation of clinical outcomes between patients undergoing PFO + HTO versus HTO alone. Functional outcome of ten patients in either group was assessed by Oxford Knee Score and Western Ontario and McMaster Universities score. Results: Patients undergoing PFO + HTO had a larger degree of angular correction. There were lesser complications related to HTO (no delayed union and nonunion). Furthermore, there was no loss of limb alignment. However, peroneal nerve (transient) palsy was reported in this group. Overall, patients had better pain relief and improved scores in the PFO + HTO group. Conclusion: PFO seems to be beneficial (albeit statistically insignificant in our cohort) in medial open-wedge osteotomy by allowing compression and promoting union at osteotomy site, maintaining limb alignment for longer period, and providing bone graft for osteotomy site. We recommend a larger prospective study to study the benefits of PFO + HTO for correction greater than 10°, osteoporosis, iatrogenic fracture of lateral cortex of tibia, and slope correction osteotomies. Care should be exercised while handling the common peroneal nerve during PFO.
{"title":"Combining proximal fibular osteotomy with high tibial osteotomy – Is it better than high tibial osteotomy alone? Comparative evaluation of early outcome","authors":"S. Baliga, Pausiam Tunglut, P. Arya, M. Mallick","doi":"10.4103/jotr.jotr_20_21","DOIUrl":"https://doi.org/10.4103/jotr.jotr_20_21","url":null,"abstract":"Introduction: Valgisation high tibial osteotomy (HTO) is a widely performed procedure for patients with medial compartment unicompartmental osteoarthrosis knee with varus malalignment of lower limbs. Over the last two decades, medial open-wedge HTO has been more popular than lateral closed-wedge techniques due to multiple advantages. Recently, isolated proximal fibular osteotomy/fibulectomy (PFO) has been advocated as a treatment for medial tibiofemoral osteoarthrosis in young patients. The role of fibulectomy as an adjunct to medial open-wedge HTO has been scarcely reviewed in the literature. Materials and Methods: This study is a retrospective comparative evaluation of clinical outcomes between patients undergoing PFO + HTO versus HTO alone. Functional outcome of ten patients in either group was assessed by Oxford Knee Score and Western Ontario and McMaster Universities score. Results: Patients undergoing PFO + HTO had a larger degree of angular correction. There were lesser complications related to HTO (no delayed union and nonunion). Furthermore, there was no loss of limb alignment. However, peroneal nerve (transient) palsy was reported in this group. Overall, patients had better pain relief and improved scores in the PFO + HTO group. Conclusion: PFO seems to be beneficial (albeit statistically insignificant in our cohort) in medial open-wedge osteotomy by allowing compression and promoting union at osteotomy site, maintaining limb alignment for longer period, and providing bone graft for osteotomy site. We recommend a larger prospective study to study the benefits of PFO + HTO for correction greater than 10°, osteoporosis, iatrogenic fracture of lateral cortex of tibia, and slope correction osteotomies. Care should be exercised while handling the common peroneal nerve during PFO.","PeriodicalId":34195,"journal":{"name":"Journal of Orthopedics Traumatology and Rehabilitation","volume":"40 1","pages":"59 - 65"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90867175","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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