Introduction: Osteoarthritis (OA), with prevalence as high as 17 to 60.6%, is estimated to be the fourth leading cause of disability. There has been an increase in prevalence of knee osteoarthritis by as much as 100% since the mid-20th century.
OA has no specific cure. In advanced stages the patients have no option apart from under going joint replacement surgery with its own risks and limitations. Therefore, there has been renewed interest in those treatment options which could avoid or delay a joint replacement and make patient comfortable till surgery becomes an absolute indication. Of those available, therapies like viscosupplementation and PRP therapy have showed promise in various studies.
The aim of this study is to assess the functional outcome of the therapeutic values of a Novel Platelet Rich Plasma (PRP) regimen in knee osteoarthritis by VAS and WOMAC and IKDC score.
Materials and Method: The present prospective study of 50 cases was conducted in the Department of Orthopaedics, Rohilkhand Medical College, Bareilly. All patients affected by a Unilateral or Bilateral knee osteoarthritis of all radiological grades (grade 1-4), attending the department from November 2016 to October 2017 were invited to participate in the study.
The cases of knee OA were radiologically classified by the Kellegren Lawrence Grade. The patients were administered with 3 doses of Novel regimen of intra-articular PRP and were followed up till 6 months post therapy. The functional outcome in the patients was assessed by the WOMAC, IKDC and VAS scores.
Results: A significant change in WOMAC score was observed. The range of change in WOMAC score at 1 week to 6 months follow up was 9.85% to 24.84%. Changes in WOMAC score at all the follow up visits were statistically significant (p<0.001). A subsequent decline in pre-treatment VAS score (Pain) was also observed at follow up visits at 1 week (1.15±0.69; 18.18%), 3 months (2.07±1.03; 32.63%) and 6 months (2.29±1.29; 36.14%).
Conclusion: The Novel PRP regimen is a very good alternative treatment modality in patients with knee OA from KL grade 1 to grade 3 to delay the progression of the disease. It provided significant symptomatic improvement along with improvement in the functional outcome of the patients without any severe side-effects.
Purpose: Non-union is an irreversible stage in cascade of fracture healing devoid of all potentials of regeneration. Etiology of nonunion is multifactorial, categorized into mechanical, biological and infective. Implant failure is a consequence, not cause of non-union. Failed post osteosynthesis non-unions following once/multiple surgical interventions is challenging due to previous fibrous and scar tissues, osteoporosis, compromised vascularity of bone and soft tissues, dormant infection and presence of failed implant. This study aims to propose a treatment protocol for refractory non-unions of diaphyseal fractures with co-morbidities optimization.
Method: Fourteen patients having post plating non-union in humerus (n=8), femur (n=5), tibia (n=1), subjected to dual-plating, the first plate applied on tensile surface of bone which is larger than second orthogonal plate. Osteo-periosteal decortication and cancellous bone graft carried out in every patient with atrophic non-union. Reborne bone healing score for radiological union was used to assess results. ICC (Intraclass Correlation Coefficient) was calculated.
Result: All patients followed till union. On average non-union of humerus took 4 months while femur, tibia took 6 months to heal. All patients regained functional stable limb with painless range of motion. The ICC increased to 0.94 (95% CI 0.90 to 0.96), showing almost perfect agreement.
Conclusion: Favorable mechanical and biological environments in absence of infection provided by dual plating, decortication and bone grafting converts non-union into osseous union. Dual plating increases strength and stiffness of construct providing stability, decortication and cancellous bone-graft re-initiates cellular and bio-chemical responses for healing.
Objective: To correlate the findings of conventional radiography and magnetic resonance imaging in acute and chronic cases of seronegative spondylo-arthropathies and also to correlate the outcomes of different sequences of MRI especially STIR and Gadolinium contrast-enhanced TIWI with emphasis on sacroiliac joints.
Methods: A total of 100 cases were included in this prospective case study who was met the ASAS criteria. Firstly, radiographic findings in all the cases were evaluated and were graded (0-4) according to modified New York Criteria 1984. Secondarily MRI of the pelvis was done including bilateral sacroiliac and hip joints. An axial oblique and semicoronal section were obtained along the long axis of sacral bone with TIWI, STIR, and post-gadolinium T1W MRI findings like; periarticular bone marrow edema, capsulitis, synovitis, enthesitis, erosion, and ankylosis were noted and analysed. Biochemical investigation ESR, Rheumatoid factor, C-reactive protein, and HLA-B27 were also done.
Results: Among MRI findings suggestive of acute sacroiliitis, the most common was BME (41%) followed by synovial enhancement (14%), enthesitis (8%) and capsulitis (6%) respectively. Post-gadolinium TIWI showed significant synovial enhancement in the younger (<19 years) age group.
Conclusions: HLA B-27 had a strong association with the SpA. However, further studies with a larger sample size are needed. ESR and CRP were found to be good laboratory marker for SpA activity. STIR and T1WI MR sequences were sufficient for making the diagnosis of either active or chronic sacroilitis. Synovial enhancement on the post-contrast T1W sequence was statistically significant (p <0.001) in pediatric patients than adults.
Background and Objectives: Clavicle fractures account for 3-5% of all fractures, of them 70-80% are middle shaft fractures. Conservative management was treatment of choice in past but due to increased fracture rates and dissatisfaction of patients due to nonoperative treatment; management of these fractures has shifted to operative one. Early complications are neurovascular bundle injury, skin laceration, bleeding. Late complications include malunion leading to shoulder shortening. Newer method for clavicle fracture is intramedullary nailing using Titanium elastic nails. TEN is flexible and assume s shape of clavicle and holds the fragments in-situ by 3 points fixation principle. It also prevents the rotation, angulation and shortening of fragments.
Materials and Methods: A study of 30 cases was conducted at Department of Orthopedics, Rohilkhand Medical College Bareilly from November 2018 to November 2019. These patients operated with titanium elastic nail (TEN) with follow up for 6 months included.
Results: Majority of patients in our study 13 patients (43.3%) were in the age group of 25-35 years. The average age was 38.7±11.4 yrs (range from 25 to 60). 23 patients were successfully treated with closed reduction and nail insertion while 7 patients had to undergo mini-open (minimal incision) for fracture reduction. Mean operative time was 23.5 minutes (15-38.5 minutes). Out of 30 patients 26(86.67%) had excellent outcome, 2(6.67%) had fair outcome, 1(3.34%) had good outcome and 1(3.34%) had poor outcome.
Conclusion: The study shows that fixation of clavicular fractures with Titanium Elastic Nailing System (TENS) is easy to do procedure which gives faster pain relief, speedy functional recovery. Moreover, the Cosmetic problems due to post- operative scar and other postoperative complications are lower.
Background: Recurrent anterior shoulder dislocation is not uncommon. Although the etiology for recurrent anterior shoulder dislocation is not very clear, there are 3 lesions usually responsible for its occurrence: Bankart lesion, Hill-Sachs lesion and laxity of subscapularis muscle. Several operations have been described for the treatment of recurrent anterior dislocation of shoulder but only a few of them have good result in terms of recurrence and loss of shoulder movement in follow-up period. Modified Boytchev procedure is an effective, technically simple procedure for the management of recurrent anterior dislocation of shoulder.
Methods: Ten patients with recurrent anterior dislocation of the shoulder were treated from September 2017 to August 2019 by the modified Boytchev procedure. The age of the patients varied from 20 to 38 years (average 25.6 years). Outcome was evaluated using the Burkhead and Rockwood criteria, a score of 90 to 100 was considered excellent, 70 to 89 good, 40 to 69 fair and ?39 was considered poor.
Results: The mean follow-up period was 15.4 (SD=3.2; range=6-29) months. Outcome was excellent in 7 patients, good in 2, and fair in 1. None had poor outcome. The shoulders were stable with increased ROM in all directions. Mean external rotation deficit at 0o and 90o of improved from 18o to 7o and 21o to 10o respectively (student's paired t-test).
Conclusions: This is an effective, technically simple procedure with minimum restriction of movements around the shoulder joint and does not require expert skills.
Background: The aim of this study was to evaluate the outcomes of patients with distal humerus fractures in adults, treated with triceps-reflecting and olecranon osteotomy approaches. Outcome in terms of: (l) Accuracy of articular reduction, (2) Operative time, (3) Blood loss, (4) Functional result and (5) Immediate, early and late complications were compared.
Methods: Thirty three patients with distal humerus fractures were analyzed prospective and retrospectively. Fractures were classified using the AO/ASIF classification. Functional results were evaluated with the Mayo elbow performance score (MEPS) and the Disabilities of Arm, Shoulder and Hand (DASH) questionnaire score.
Results: The accuracy of articular reduction is better in olecranon osteotomy (Group-A) than the Triceps reflecting (Group-B) approach. The average time taken from incision to wound closure was 92.62 ± 8.73 minutes for group A and 78.63 ± 7.02 minutes for Group B, the P value being <0.001 which was statistically highly significant. The average blood loss from incision to wound closure was 222.78 ± 34.93 ml for group-A and 121.61 ± 19.85 ml for group-B, the P value being <0.01 which was also statistically highly significant. The mean arc of motion in patients of group A was 91.04° ± 13.55° and in group B was 92.65° ± 19.07°. The difference in range of motion was statistically insignificant. On comparing the mean MEPS and DASH score in group A and group B was also found non significant (P value for both >0.05). The complications like, soft tissue infection, ulnar nerve neuropraxia and implant prominence where observed more in trans olecranon group.
Conclusion: Triceps reflecting approach provide lesser operating time, lesser blood loss, low complications rates. On the other hand olecranon osteotomy provide better accuracy of articular reduction (can be reserve for C3 fracture). There were no significant difference between the two groups in term of functional outcome, although second surgery for hardware removal was required in almost all cases of olecranon osteotomy group patients. olecranon osteotomy was use in 21 patients (group A, 10 female, 11 male with mean age 43.23 years) and triceps reflecting approach was used in 12 patient (group B, 6 female, 6 male with mean age 35.83 years).
Introduction: The present study compares functional outcome of acromioclavicular joint reconstruction using the Modified Weaver Dunn method with palmaris longus tendon for coracoclavicular reinforcement and flip-button technique.
Materials and Methods: 60 patients (32 males and 28 females) with fresh acromioclavicular joint injury, between the age group of 1860 years, were operated using the Modified Weaver Dunn method with palmaris longus tendon for coracoclavicular reinforcement and flip-button technique at our Department from July 2015 to July 2018 after obtaining approval from local ethical committee. Patients were followed up post-operatively for difference in range of motion at 6 weeks, 12 weeks, 24 weeks and 48 weeks as well as 6 monthly thereafter. All the patients were assessed with Constant and Murley Scoring System.
Results: At the follow up of 2 years, there was no significant difference in trauma surgery delay, operative time and perioperative blood loss between the two groups. However, the mean constant score improved from 66.56±14.43 to 94.30±7.29 in the Modified Weaver Dunn Method group and in the flip-button technique group from 55.14±15.36 to 84.86±11.37. 87.5% (28 out of 32) patients in Modified Weaver Dunn method had excellent results subjectively, while 85.71% (24 out of 28) patients in the flip-button technique had satisfied results. 2 patients had loss of reduction and superficial wound infection seen in 2 patients of the Modified Weaver Dunn Method group. Loss of reduction seen in 4 patients in the flip-button technique group.
Conclusion: Modified Weaver Dunn method was associated with a high patient contentedness, promoted earlier postoperative range of motion, rehabilitation and facilitated earlier return to sports therefore effectively be used for reconstruction of acromioclavicular joint dislocation Rockwood type III and above and had excellent functional outcome in comparison to flip-button technique
We are describing a variation of sciatic nerve (SN) found during Kocher-Langenbeck (KL) approach in a case of acetabular fracture. The Sciatic nerve, in our case had two separate components before uniting. Common peroneal component (CPN) was passing right through the piriformis muscle (PM) before exiting whereas the tibial component (TN) was lying underneath (anterior to) the piriformis. (Type B as per Beaton and Anson classification). From literature review, we found that anatomical variations of SN have been described to be around 13% across both cadaveric studies and magnetic Resonance Imaging (MRI) based studies. Type B is the most common variant which has been found in 8% of cases. However, amongst cadaveric studies done in India, it has been found to an extent of just 2%. Knowledge of variations in anatomy of SN in relation to PM is important for acetabular surgeons to avoid iatrogenic injury to the sciatic nerve.
Background: Monteggia fracture-dislocation is a rare entity in adults with an incidence of less than 1%. However a combination of fracture shaft humerus with distal intraarticular extension along with monteggia fracture dislocation in an ipsilateral upper limb is very hard to find and manage, owing to its rare presentation.
Material: In this report we detailed the surgical management of comminuted fracture(splinter) of shaft humerus with intercondylar extension AO C2 with typeII monteggia fracture dislocation with the usage proper implants in an 25 year old male with a 3 year follow up.
Result: It shows that the fracture united well at appropriate time period and elbow range of movements were satisfactory ranges from 20° to 130° with no limitation in supination and pronation.
Conclusion: Such a complex elbow injuries are difficult to find in the literature. This study addresses the proper surgical management in terms of approach and usage of appropriate implants to improve the long term functional outcome when dealing with such a injuries.
Chondroblastoma is an uncommon benign bone tumor, involving the epiphysis of long bones. An 18-year-old male presented with complaints of pain and swelling in the right knee joint for the last one year. On clinical and radiological examination a differential diagnosis of the following benign tumors were considered: Chondroblastoma, Simple bone cyst, Aneurysmal Bone Cyst, Epiphysial Giant Cell tumor. A final diagnosis of aneurysmal bone cyst was made after histopathological confirmation. Radiologically the lesion resembled chondroblastoma. The patient was operated by curettage and bone grafting and he was asymptomatic one year after the surgery.
The COVID-19 pandemic disrupted the major healthcare services around the world. Elective surgeries and outpatient services have been majorly deferred. As the risk of SARS-Cov-2 infection may persist for a prolonged duration, there is a need for gradual resumption of the routine orthopaedic services. This brief communication discusses the measures to reduce the burden on orthopedic OPDs without affecting the quality of patient care in the current pandemic situation.
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