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   2015| January-April  | Volume 8 | Issue 1  
    Online since June 13, 2016

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Functional outcome in tibial spine fracture treated with arthroscopic pull through suture technique
Vikram Sapre, Samir C Dwidmuthe, Vaibhav Bagaria, Sidharth Yadav
January-April 2015, 8(1):6-10
Introduction: Various fixations techniques are available for fixation of tibial spine avulsion fracture. Arthroscopic assisted fixation can be achieved by screw fixation, pull through sutures, and using suture anchors. We conducted a prospective study to analyze the results of arthroscopic assisted pull through suture technique for treatment of tibial spine avulsion. Materials and Methods: Ten patients with displaced tibial spine avulsion fractures without other associated ligament injuries were included in the study. Ten patients (2 female and 8 male) with a mean age of 29.2 years (19-42 years) underwent arthroscopic assisted fixation with pull through suture technique. The postoperative results were analyzed using clinical tests, radiological evaluation and International Knee Documentation Committee (IKDC), Lysholm score and Tegner activity level. Observations and Results: The mean follow-up period was 21.7 months. We evaluated all patients at 18 months after the surgery. Radiographs showed that all fracture healed anatomically at an average duration of 3 months after surgery. At the final follow-up, all patients reported no symptoms of instability, such as giving – way episodes, clinical signs of anterior cruciate ligament deficiency were negative. The mean Lysholm score was 96.9 (range 91-100), mean IKDC score was 87.9 (range 83-93), and all patients achieved their pre injury Tegner activity levels. One patient had postoperative arthrofibrosis with the loss of terminal extension of 5° which responded to arthroscopic adhesiolysis and physiotherapy. We had no case of infection. Conclusion: Arthroscopic suture pull through a technique for tibial spine fracture is a minimally invasive technique with good functional and radiological results with a lesser risk of arthrofibrosis, infection, and need for hardware removal.
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To study the pattern of bacterial isolates in open fractures
Digvijay Agarwal, Rajesh Maheshwari, Atul Agrawal, Vijendra D Chauhan, Anil Juyal
January-April 2015, 8(1):1-5
Introduction: Open fractures are fairly common in developing countries. Causes of open fractures vary widely including road traffic accident, fall from height, gunshot, assault, machine injuries and others. Infection is a common complication of open fractures. Chronic osteomyelitis, nonunion, loss of function or even limb loss are some serious outcome of deep fracture site infections. Primary goal in management of open fractures is prevention of infection of bone and soft tissue by early debridement, irrigation of wound and administration of broad spectrum antibiotics with stabilization of fractures. Aim: The aim of the study is to elucidate pattern of microbial isolates in open fractures so as to form rationale antibiotic regimen for treating open fractures. Methods: 70 patients were taken into study of all ages, both the sexes with open fracture classified according to Gustilo Anderson classification. Primarily wound was examined and description of the wound was recorded with 1st culture swab taken at that time followed by 2nd culture swab on 1st dressing after debridement and 3rd culture swab if infection continues further. Culture and sensitivity reports were collected for studying pattern of bacterial isolate and their sensitivity. Results: Pre-debridement cultures are of no importance. Post-debridement cultures are important in formulating an antibiotic regime. Gram negative organisms are the most probable cause of infection. Aminoglycosides are the most sensitive group of drugs in both gram positive and gram negative bacteria. Cephalosporins or quinolones should be used in combination with aminoglycosides in all cases of open fracture in our vicinity. Conclusion: All institutions and hospitals should find out the most common infecting pathogen in their environment and formulate an antibiotic policy accordingly.
  2,377 3,943 1
Outcome of intertrochanteric fractures treated with proximal femoral nail: A prospective study
Preetesh Endigeri, OB Pattanashetty, Dayanand B Banapatti, Arravind Pillai, T Ullas
January-April 2015, 8(1):25-29
Introduction: Intertrochanteric fractures are common in the elderly especially with the increase in the incidence of osteoporosis. Various studies have shown good results when treated with intramedullary devices such as the proximal femoral nail (PFN) while other studies have shown high rates of complications. Aim: To study the outcome of intertrochanteric fractures treated with proximal femoral nailing by using Kyle's criteria. Materials and Methods: The study involved fifty cases of intertrochanteric fractures of femur that were treated with PFN. Fractures were classified using Orthopaedic Trauma Association classification. Patients were followed up at 4 weeks, 3 months, and 6 months and results were evaluated using Kyle's criteria. Results: The study included fifty patients, 32 males and 18 females of age 38-94 years with an average of 57 years. Excellent and good results were found in 44 patients (88%). Intra- and post-operative complications were found in 12 patients (24%). Conclusion: Good fracture reduction is critical in the management intertrochanteric fractures with PFN. Proximal femoral nailing is an excellent treatment option for unstable intertrochanteric fractures.
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Primary plate osteosynthesis in compound fractures of proximal and distal tibia by locked anatomical plate using minimally invasive technique: Our experience of 94 cases
Simrat Pal Singh Gill, Manish Raj, Dinesh Kumar, Jasveer Singh, Prateek Rastogi
January-April 2015, 8(1):16-24
Introduction: Juxta-articular or intra-articular compound proximal tibia fractures presents a great therapeutic challenge to an orthopaedic surgeon. The treatment of this kind of fractures is often complicated either by the patient's compromised general conditions, or by soft tissue damage. The development of biological techniques in plate fixation and the design of implants which cause the least possible interference with the periosteal blood supply have enhanced the use of plates and screws for stabilisation of open proximal tibia fractures. The primary aim of this study is to assess the role of biological plate fixation in compound proximal and distal tibia fractures. Material and Method: We selected 94 patients of compound proximal and distal tibia fractures including Gustilo and Anderson type 1,2 and 3A. Our protocol included debridement, irrigation, and splint casting in emergency room with definitive stabilization with the biological plate through minimally invasive surgical techniques if the soft tissue injury and wound allowed. Patients were followed up for at least two years. Outcome were measured using knee society clinical rating score for proximal tibia fracture cases and Modified American Orthopaedic Foot and Ankle Society score (AOFAS) for distal tibia fracture cases. Results: Further, final outcome of these patients was assessed after 2 years of follow-up using Knee society score. Excellent results were seen in 35(73%) cases and good result in 10 (20.8%) cases. Three cases show fair to poor score and all these cases were from compound Grade III group. one case required early plate removal and external fixation and showed poor result. Functional outcome of distal tibia fracture cases was assessed with the modified AOFAS ankle-hind foot score at final follow-up. Out of the 40 cases, 20(50%) shown excellent result. Out of the 40 cases, 14 (35%) shown good result. Overall good to excellent result was seen in 34 (85%) cases. Two cases showed fair result and poor result was seen in 4 (10%) cases. Discussion: The biological plate presents another good option in the treatment of open fractures in open proximal and distal tibial fractures. The combination of minimal soft tissue dissection, small surgical approaches, and plates that do not compress the bone, yield an implant that would be expected to yield a lower rate of infection than other alternative methods in treatment of open proximal tibial fracture.
  2,672 395 -
Functional outcome of conservative and surgical management in mid-third clavicle fractures
Chandra Prakash Pal, Rajendra Kumar Shakunt, Deepak Kumar, Amrit Goyal, Aditya Prakash Tyagi, Trilok Chand Pippal
January-April 2015, 8(1):11-15
Purpose: Clavicle fracture traditionally treated conservatively. There is a growing trend to treat displaced mid-shaft clavicular fractures with primary open reduction and plate fixation; whether such treatment results in improved patient outcomes is debatable. The aim of this study was to compare union rates and functional outcomes for displaced mid-shaft clavicular fractures that were treated with either primary open reduction and plate fixation or nonoperative treatment. Material and Methods: In this prospective study, 32 patients between 18 and 60 years of age who had an acute displaced mid-shaft clavicular fracture were randomized to receive either primary open reduction and plate fixation (n = 12) or nonoperative treatment (n = 20). Functional assessment was conducted at 3 months, 6 months, and 1-year with the use of the constant scores. Union was evaluated clinically and radiographically. Complications were recorded and compared. Results: The rate of nonunion was significantly reduced after open reduction and plate fixation (none nonunion) as compared with nonoperative treatment (two nonunion). Constant scores were significantly better after open reduction and plate fixation than after nonoperative treatment; 93.7 versus 85.5. A major complication was found in 35% of patients in the conservative group while they were absent in operative group. Conclusions: Open reduction and plate fixation reduces the rate of nonunion after acute displaced mid-shaft clavicular fracture compared with nonoperative treatment and is associated with better functional outcomes. Open reduction and plate fixation using precontoured locking plate have low implant-related complications.
  2,053 590 -
Congenital pseudarthrosis of clavicle: A rare presentation
Alok C Agrawal, Bikas Sahoo, Harshal Sakle
January-April 2015, 8(1):54-57
Congenital pseudarthrosis of the clavicle (CPC) is a rare malformation of unknown etiology. Not many cases are reported in the literature so far. The child is usually asymptomatic and presents with a swelling in the midportion of the clavicle. The diagnosis can be confirmed by X-rays. Surgical treatment is indicated in symptomatic patients or those with major deformity. We present a case of the right side CPC in a 16-year-old female patient managed surgically in our hospital. Patients with CPC usually present early due to cosmetic deformity, but our patient presented quite late due to negligence. Surgical treatment was performed, with resection of fibrous pseudoarthrosis, internal fixation with locking compression plate, and iliac bone graft. CPC should be included in the differential diagnosis of clavicle abnormalities in children. Good results can be achieved with surgical techniques in patients with indication.
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Management of idiopathic congenital talipes equinovarus by standard versus accelerated Ponseti plaster technique: A prospective study
Biswajit Sahu, Rajesh Rajavelu, Barsha Tudu
January-April 2015, 8(1):30-34
Introduction: Ponseti technique has been accepted as the standard method of treatment for clubfoot. Accelerated Ponseti method with casts being done twice weekly, is being utilized recently to reduce the duration of plaster treatment. Materials and Methods: A prospective study was done in 80 feet (53 patients), who were randomly allotted with 40 feet in standard group and 40 feet in accelerated group. In standard group, manipulation and casting were done at weekly intervals, whereas in accelerated group, the same was done at 3 days interval. The initial and final Pirani score, number of casts required, duration of casting and relapse after treatment were recorded for all cases in both the groups and the results were analyzed. Results: Average initial Pirani score was 5.03 and 5.3 in standard Ponseti group and accelerated Ponseti group, respectively. The average final Pirani score was 0.2 and 0.25 in standard Ponseti group and accelerated Ponseti group, respectively. The average number of casts required for correction was 6.2 and the average duration of casting was 8.2 weeks in standard Ponseti group. The average number of casts required for correction was 7.4, and the average duration of casting was 3.4 weeks in accelerated Ponseti group. Conclusion: The advantage of accelerated Ponseti is early correction of the deformity with better acceptability by the parents. Accelerated method can be considered as an effective alternative method for correction of clubfoot.
  1,255 274 2
Clavicular fracture in a national wrestler: A case report of rapid return to play
Erdinc Acar, Serdar Toker
January-April 2015, 8(1):46-49
The objective of the present study was to present the case of surgical treatment and rehabilitation of a midshaft clavicular fracture in a national wrestler. This is a case report of a 20-year-old female national wrestler who met a motorcycle accident (July 9, 2014). Postinjury radiographs revealed a midshaft clavicular fracture. She came a month after the accident. She had got a pain. Differential diagnosis revealed spiral oblique midshaft clavicular fracture. The sports medicine staff discussed surgical and nonsurgical options. A surgical procedure of internal fixation with an 8-hole anatomic clavicula plate was performed. In August 2014, she had surgery at Emirdag/Afyon County Hospital. Surgical treatment for clavicular fractures is becoming increasingly common. We suggest that new rehabilitation protocols for clavicular repairs should be investigated now that surgical treatment is being pursued more frequently. More aggressive treatment procedures and rehabilitation protocols for clavicular fractures have evolved in recent years. With these medical advancements, athletes are able to return to play much more quickly without compromising their health and safety.
  1,318 97 1
Congenital pseudoarthrosis of ulna
Sanjay Keshkar, Nirmal Dey, Deepak Dalmia
January-April 2015, 8(1):50-53
Isolated congenital pseudoarthrosis of the ulna is a rare entity. We present such a case of a 12-year-old boy, who was referred to us for deformity of his right forearm (since birth), and pain on the right hand with exertion. The examination and investigation confirmed the diagnosis of congenital pseudoarthrosis of the ulna, which was associated with neurofibromatosis and was treated by the creation of one bone forearm as a salvage procedure.
  1,185 105 -
Actinomycosis knee joint: An atypical presentation
Rajesh Goel, Avinash K Rai, Surender Kumar, Rajeev Saxena
January-April 2015, 8(1):42-45
We are reporting an unusual case of actinomycosis which presented to us as a osteolytic lesion in distal femur. Diagnostic confusion leads to delayed medical therapy, increased morbidity and involvement of nearby bone that is, patella. Actinomycosis being an endemic disease and its ability to mimic many skeletal pathology, this should also be included in the differential diagnosis specially when the patient did not fit in to primary diagnosis and respond favorably to treatment given.
  1,049 104 -
Long angular stable plates: A solution for complex fractures of humerus
Vipin Sharma, Seema Sharma, Bhanu Awasthi
January-April 2015, 8(1):35-38
Segmental fractures of humerus are difficult to treat. Various options exist for treating ipsilateral metadiaphyseal fractures of humerus but have their own set of complications. Management of these fractures with long angular stable plates gives us an advantage of treating these two level fractures simultaneously thereby reducing complications and postoperative morbidity. Applying minimally invasive plate osteosynthesis (MIPO) principles helps in the biological healing of fracture by being minimally invasive and preserving blood supply to the soft tissues. We are presenting a small series of ipsilateral metadiaphyseal fractures humerus using long angular stable plates in an MIPO fashion.
  999 99 1
A neglected case of Klippel Trenaunay Weber syndrome
Vikram Khanna, Gaurav Singh, Sanjeev Kumar, Sudhir Singh
January-April 2015, 8(1):39-41
This congenital vascular disorder is described by a “triad” of symptoms affecting one or more limbs. The “triad” constitutes varicose veins, cutaneous hemangioma, with bone and soft tissue hypertrophy. The cutaneous hemangioma presents as a substantial port-wine stain or nevus. Varicose veins are often very numerous. Bone and soft tissue hypertrophy is variable in presentation and the affected limb may be either larger or smaller than the normal limb. This disorder is generally reported in childhood or adolescent age groups. We herein present a neglected case of Klippel Trenaunay Syndrome with all the classical clinical and radiological findings. A 30-year-old man reported with the classical triad. On clinical examination substantial port wine stain was seen and radiographs showed multiple bony outgrowths whereas MRI showed multiple varicosities displaying heterogeneous hyper intense signals on T2 Weighted Images and T1 hypo intensity with hypertrophy of soft tissue in left lower limb.
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Lepra reaction mimicking prosthetic joint infection following total hip replacement: An unusual complication
Alok C Agrawal, Bikas Sahoo, Harshal Sakle
January-April 2015, 8(1):62-66
Joint replacement is a highly effective intervention that significantly improves patients' quality of life. Infection is a dreadful complication in total hip replacement (THR). Managing the prosthetic joint infection is a difficult task for surgeon. In today's era, patients with chronic mycobacterial infections are also treated with total hip arthroplasty. We are reporting a case who had lepromatous leprosy 5 years back treated as per the schedule who developed lepra reaction later. After treatment of lepra reaction, the patient developed avascular necrosis of femoral head. A hybrid THR was done for that to the patient. The report discusses lepra reaction following THR mimicking acute infection. In the literature, there are no reported cases of lepra reaction in a patient with THR done. Our case report presents with the dilemma of diagnosis between infection and lepra reaction following THR.
  894 116 -
Delayed lower leg compartment syndrome in the uninjured limb following hemilithotomy positioning: Report of three cases, review of the literature, and recommendations for prevention
Medhat Zekry, Girgis Saad, James Ramos, Habib Rahman, Jamal Almulla
January-April 2015, 8(1):58-61
Compartment syndrome in the uninjured leg as a complication of prolonged positioning in a hemilithotomy position is a serious complication. Prolonged operative time, external compression, and elevation of the sound leg are contributing factors. This is a devastating, but rare complication in the uninjured leg
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