Skeletal fluorosis is an endemic disease in some regions of Southeast Asia. Diagnosis is made mainly by radiographs seeing osteosclerosis. Other causes of osteosclerosis have to be ruled out. Treatment is done mainly for symptoms.
Background: Osteochondral lesions in young adults, if left untreated invariably progresses to degenerative joint disorders. The problem adds a burden on finances and average productivity of the patients and countries' economics. Among the known strategies for treatment, none has proven to be gold standard, and each one is having their own pros and cons. Osteochondral tissue engineering (OTE) offfers a promising future where cultured chondrocytes can be grown on biocompatible biomaterial scaffolds and implanted on defects.
Materials and Methods: We tested a novel three-dimensional scaffold using chitosan and poly-L-lactide (PLLA) in recommended proportion on animal experimental model. It was seeded with autologous chondrocytes harvested from tibial condyle of rabbits. 10 rabbits were implanted with this cell-seeded scaffold and were followed at 4, 8, and 12 weeks before being sacrificed. Histological and gross examination was graded on a rank scale. It was compared between the implanted knee and contralateral control void. Values were examined statistically.
Result: Outcome shows good quality of cartilage tissue, less fibrotic growth, better amalgamation with the surrounding tissue, uptake at the implanted bed, and regular proliferative growth as early as 8 weeks. The scaffold imparts structural stability to the chondrocytes. The scaffold does not interfere with the normal healing process and was less inflammatory by 12 weeks.
Conclusion: OTE with bioscaffold using PLLA-chitosan and cultured chondrocytes has positive and promising outcomes in healing of cartilage defects.
Club foot is amongst the most common of congenital deformities.CTEV is a complex three dimensional deformity having four components-equinus, varus, adduction and cavus.The present study was conducted to compare the results of PMSTR and JESS fixator in neglected, resistant and relapsed or recurrent club foot .This prospective study comprising of 36 children, was conducted in the department of orthopedics, S.N.Medical College Agra. Preoperative none of the feet in either group had a clinical satisfactory rating but after surgery a significant improvement was seen. Of the 25 feet subjected to PMSTR procedure it was observed that 16 feet (64%)were in the category of satisfactory rating where all the 9 clinical criteria were in satisfactory range (36 %) had unsatisfactory result. Of the 22 feet subjected to Differential Distraction Method usingJESS FIXATOR it was observed that 19 feet (77.3%) were in the category of satisfactory rating, where all the 9 criteria were in satisfactory range, unsatisfactory result were seen in 5 feet (22.7%).
Introduction: Proximal humerus fractures account 4-5% of all fracture and are not uncommon especially in older age groups. About 85% of fractures of proximal humerus are minimally displaced and are effectively treated by immobilization followed by early motion. Displaced proximal humerus fractures can be treated both conservatively and by open reduction internal fixation by locking compression plate for better functional outcome.
Material and Method: Over a period of 14 months 34 elderly patients of proximal humerus fractures were admitted and randomly divided into 2 groups. 18 were treated surgically and 16 conservatively. Patients treated conservatively by Shoulder Immobilizer/ Uslab/Cast.Patients who are treated surgically were taken up for open reduction and internal fixation by locking compression plate using deltopectoralapproach. Patients were followed at 3wk,6wk,3month,6month, 9month and 12 month and were assessed for pain range of motion, strength using constant and murley shoulder score.
Results: In the conservative group 31.3% of the patients had poor constant scores 37.50% had moderate constant scores and 31.30% had good constant scores. While in surgical group 27.80% had poor constant score 11.10% had moderate constant scores and 61.10 had good constant scores suggesting that surgical group has better functional outcome but in long term follow up there is not much difference other than the initial pain in the conservative group. This difference could not be proven statistically as the p value was 0.126 which is statistically insignificant.
Conclusion: In this prospective comparative study, conservatively treated patients had good functional outcome with good range of movement .In elderly patients with osteoporotic bone, locking plates do well but there is no significant difference in long term follow up in the outcome of patients treated conservatively or surgically.
Background: Giant cell tumors are an aggressive and potentially malignant lesion that is commonly treated by surgery involving bone grafts or synthetic bone void fillers. Although synthetic bone grafts may provide early mechanical support while minimizing the risk of donor-site morbidity and disease transmission, difficult manipulation and less than optimal transformation to bone have limited their use.
Materials and Methods: In a prospective series, 14 patients of giant cell tumour with a mean age of 25 years (20-30 years range) were treated by extended curettage followed by the use of a biphasic (composed of two components 60% weight synthetic calcium sulfate and 40% weight hydroxyapatite powder) and injectable ceramic bone substitute (CERAMENT TM BONE VOID FILLER, BoneSupport, Sweden). The most common location was proximal tibia (n = 6), followed by distal end of femur (n = 5), distal end humerus (n = 2), and distal end of radius (n = l). Patients were followed clinically and radiologically for 6 months. Serial X-rays were performed thereafter to look for recurrence and bone remodeling of the bone substitute. All lower limb patients were allowed partial weight bearing immediately after surgery. All upper limb patients were allowed the active gentle range of movement exercises after surgery.
Results: Lesion started bone remodeling by 2-3 months. After 6 months, the defects completely demonstrated full resolution. A serous discharge, probably response to cerament, was noted in all patients postoperatively that resolved within 2-3 weeks spontaneously. No lesions required revision surgery during the observation period. No post-operative fracture or infection was recorded.
Conclusions: Extended curettage followed by high-speed cutting bur and cavity lavage with appropriate irrigants primary to the use of biphasic and injectable ceramic bone substitute might offer an alternative to regular bone grafting due to convenient handling properties and rapid bone remodeling.
Background: The younger generation of orthopedic surgeons having little experience with polio and its residual deformities should reinvent their skills to deal with challenge of its resurgence. Our knowledge and experience in dealing with genu recurvatum deformity with ilizarov method in polio patients need to be shared.
Materials and Methods: Twenty-four cases of genu recurvatum deformity corrected with distal femoral osteotomy and fixed with ilizarov apparatus in our center from 1994 to 2016 were evaluated.
Results: Nineteen patients had excellent results, two had good results, while three cases had fair outcome
Conclusion: Ilizarov technique has given excellent and reproducible results with minimal complications in genu recurvatum deformity in polio.
Background: Coronal plane deformity around knee persisting beyond 8 years of age is a matter of concern for a treating surgeon as well as parents. The corrective dome osteotomy surgery provides better adjustability of osteotomized fragments, large bone-to-bone contact, and stability. The present study assesses the surgical correction of angular deformities around knee in children by corrective dome osteotomy, evaluates cosmetic, functional, and anatomical outcome based on clinical and radiological follow-up, and assesses the range of motion of knee after surgical management.
Materials and Methods: A prospective clinical study was performed on 16 patients presenting with coronal plane deformity of knee, aged <16 years, and satisfying our inclusion criteria. After thorough clinical and radiological assessment, dome osteotomy was done and stabilized by cross K-wires (2.5 mm). Post-operative measurements of tibiofemoral angle (TFA), intermalleolar and intercondylar distance, scanogram for the calculation of radiological TFA, mechanical axis deviation, mechanical medial proximal tibial angle (m MPTA), and mechanical lateral distal femoral angle (m LDFA) were done and compared with pre-operative values. Patients were followed for any complication, time of osteotomy union, and range of motion of knee after operation.
Results: Out of 16 patients operated, 15 (93.75%) had valgus deformity and only 1 (6.25%) had varus deformity, and 11 were male and 5 were female; the mean time of osteotomy union was 11.88 weeks (range 8-16 weeks) and no patient had non-union. Mean valgus deformity of 28.93° improved to 8° and mean varus deformity of 10° improved to 0° post-operatively. Mean duration of cast was 7.8 weeks (range 6-10 weeks).
Conclusion: Dome osteotomy is a simple, safe, and easy procedure for correcting coronal plane deformities around knee in children before skeletal maturity. It does not cause limb length discrepancy and stable even by minimal internal fixation such as cross K-wire and plaster.
Introduction: Humerus shaft fractures are a very common entity accounting for approximately 5% ot fractures. Treating such fractures has always been the subject of debate in literature. Earlier, conservative treatment was considered to be the method of choice for managing humerus shaft fractures, but, nowadays, operative treatment is considered to be best for all such fractures.
Material and Methods: A total of 60 adult patients with post-traumatic humerus shaft fractures were included in our study. Standard radiographs were obtained. Patients were divided into nailing group (Group 1) and plating group (Group 2). They were followed prospectively for a minimum of 1 year. Fracture union was confirmed radiologically, and functional evaluation was done according to Constant and Murley shoulder score and Mayo Elbow Performance Score.
Results: The mean age of the patients was 45.25 years. Road traffic accidents were the most common cause. Fractures were classified according to AO/OTA classification. Shoulder score was excellent in 26 patients of plating group and 21 of nailing group. Excellent elbow scores were seen in 23 in plating group and 25 in nailing group. Remaining patients had good results. Average union time in nailing and plating groups was 5.5 months and 4 months, respectively.
Conclusion: When comparing the short-term results, nailing appears to be better than plating, but in long-term follow-up, both nailing and plating give equivalent results, clinically and radiologically.
The number of hip and knee replacements is increasing with better life expectancy and so is the burden of revision surgery due to periprosthetic fractures. The incidence of intraoperative periprosthetic fractures in cementless total hip arthroplasty ranges from 1 % to 20%, whereas in post-operative periprosthetic fractures, the incidence ranges between 1% and 4%. Periprosthetic fractures are associated with factors such as osteolysis, osteopenia, and aseptic loosening of the implant and usually require operative treatment. A 61-year-old man presented in emergency with a displaced fracture of neck of femur right, the patient was operated, and hemiarthroplasty was done. 3 months after surgery the patient again had a fall from height. A diagnosis of periprosthetic fracture Vancouver's classification type B was made from the radiographs. It could not be made out whether the implant was stable or unstable hence could not be classified as B1 or B2, which was later done intraoperatively. The fracture was initially undisplaced which was later found to be displaced in serial radiographs. The recommended treatment according to Duncan and Masri for type B1 fractures is a revision with a long stem. The recommended treatment, bypass with a longer stem, was impractical in this patient due to his narrow medullary canal. Hence, open reduction internal fixation by locking compression plate and cerclage was successfully completed on the patient. The economic constraints of the patient had restricted the use of cable plate.
Background: Concern for disease and perception of risk for a disease is known to affect protective behavior
Aim: to determine the effect that level of concern for osteoporosis, as well as self-perceived risk of osteoporosis and fracture, has on Supplementation use, seeking medical advice, bone mineral density testing, and anti-osteoporosis medication use
Materials and Methods: One thousand four hundred fifty six women were screened using the Global Longitudinal study of Osteoporosis in Women questionnaire to identify one thousand women who had never taken anti-osteoporotic treatment. A 3 point Likert scale was used to assess the level of concern for osteoporosis; a 5 point Likert scale was use to assess the perception of risk for asteoporosis as well as fractures. Study outcomes included calcium and vitamin D supplementation, self-reported seeking of medical advice regarding osteoporosis, BMD testing, and anti-osteoporotic medication use in one year after enrolment. Logistic regression was used in the analysis.
Results: Concern significantly increased the likelihood of seeking medical advice. However it had no significant impact on screening or treatment. Heightened self-perceived risks of osteoporosis and fracture were found to be significantly positively associated with seeking medical advice, Bone Mineral Density testing and anti-osteoporotic medication.
Conclusion: Concern increases the likelihood of seeking medical advice. Perception of risk of osteoporosis and fractures increases the likelihood of seeking medical advice, Bone Mineral Density testing and anti-osteoporotic medication.
Introduction: Modern high speed road traffic accidents and sporting lifestyle has led to an increase in the cases of ligaments injury of the knee. Anterior cruciate ligament (ACL) is the most common ligament to be injured in knee joint injuries. ACL forms pivot in the functional congruence and stability of knee joint. Reconstruction of ACL is required in most of these cases especially in younger age group. As the demand for quality of life is increasing, arthroscopic ACL reconstruction has become the most commonly performed arthroscopic procedure. At our center, we studied the outcomes of 42 patients of ACL reconstruction using quadruple hamstrings autograft. We used Endobutton for femoral end and Bioabsorbable interference screw for tibial end fixation.We measured the outcome using lysholm scale for upto 12 months.
Methods: Arthroscopic single bundle ACL reconstruction using quadruple hamstring autograft performed in total 42 knees in 42 patients those having symptomatic ACL deficient knee from feb 2016 to july 2017. 33 patients completed the follow up period of 1 year. Patients were evaluated clinically and with lysholm knee scoring at 6, 9 and 12 months after the procedure. patients showed significant improvement in knee laxity and stability. Mean Lysholm knee score was 71.78 (+/-4.92) preoperatively. There was significant improvement in score [82.l(+/-4.68) ]at 6 months, 88.81 (+/-4.59) at 9 months, and 93.9 (+/-4.20) at 12 months of post op. At 12 months ot post op 97 % patients showed excellent to good results (>83 score). Only one patient in post op at one year age present with instability, residual knee pain in 8 patients and in one patient develop stiffness of knee.
Conclusions: in this prospective study results of ACL Reconstruction with quadruple hamstrings graft are rewarding and comparable to other methods reconstructions with other graft and fixation devices in one year of follow up.
Background: Synovitis of the knee can be very difficult to treat, especially when the diagnosis remains elusive. Synovitis occurs due to the various causes. We assess the patients presenting to our hospital with synovitis of the knee, who underwent arthroscopic synovial biopsy and partial arthroscopic synovectomy, and did a review of literature.
Methods: This retrospective study included 25 patients with chronic synovitis of the knee presenting to our institution between July 2015 and January 2017. Inclusion criteria were patients presenting with persistent swelling of the knee, not responding to conservative measures. We excluded patients who had recurrent synovitis and patients who had septic arthritis. All patients underwent arthroscopic synovial^biopsy and partial synovectomy. Pre-and post-operative VAS score was calculated.
Results: In n = 5 patients, the histopathological diagnosis was tuberculosis, which improved with antituberculous drug treatment; in n = 1 patient, the diagnosis was juvenile rheumatoid arthritis; patient improved with synovectomy and NSAlDs. In n = 12 patients, the biopsy report came as chronic non-specific synovitis, 8 of these patients did well with arthroscopic synovectomy, while the other 4 had a recurrence. The average VAS score improved from 8.4 pre-surgery to 4.2 post-surgery.
Conclusions: Arthroscopic synovial biopsy and synovectomy give good results in patients with chronic synovitis of the knee. It may be recommended as a treatment for chronic synovitis of the knee, which is not responding to conservative measures of treatment.
Background: Vancouver B1 periprosthetic femoral fractures are described as fractures occurring around the stem tip in which the prosthesis is stable. Treatment options include Mennen plates (CMW Laboratories, Exeter, England), the Dall-Miles plate, cable system (Stryker Howmedica, Rutherford, New jersey), dynamic compression plates, conventional plates, cerclage cables, locking compression plates, and strut allografts with or without plating. The aim of this study was to describe the efficacy of contralateral distal femur locking plate used in reverse for the management of Type B1 periprosthetic femur fracture when used in conjunction with intraoperative demonstration of prosthesis stability and correct classification of these fractures.
Miterials and Methods: Ten periprosthetic femoral shaft fractures, Vancouver Type B1, were enrolled in the study. Average age of the patient was 57.6 years with 8 male and 2 female. All patients were managed by open reduction and internal fixation by reversed contralateral distal femur locking plate and cables and followed up for a minimum of 12 months. Patients were evaluated both clinically and radiologically.
Result: All fractures were united at an average of 14.5 weeks. Harris hip score at final follow up was 86.5. One patient had superficial wound infection. The infection was successfully treated by irrigation and debridement of wound and intravenous antibiotics.
Conclusion: We observed good functional outcome in patient treated with reversed contralateral distal femur locking plate. We conclude that reversed contralateral distal femur locking plate is a reliable, effective, and relatively cheaper option for the management of Vancouver Type B1 periprosthetic femoral shaft fracture.
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