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Indian Journal of Orthopaedics Surgery

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1 CHANGING TRENDS IN ORTHOPAEDICS, Prof. Sudhir Singh
Indian Journal of Orthopaedic Surgery (IJOS) is a peer-reviewed journal with reputable academics and experts as members of its Editorial Board. IJOS publishes information on basic and applied orthopaedics for a worldwide readership. It publishes original research papers, critical reviews dealing with all fields of Orthopaedics and it addresses the international scientific community. Papers related to orthopaedic science on a worldwide basis are also considered. Special emphasis is given to issues that go beyond the traditional boundaries of an orthopaedic journal. Articles on the state-of-the art of orthopaedic surgery in different parts of the world, the research activities and medical education in orthopaedic teaching, the role of orthopaedics in society, new findings from the frontiers of current research are always encouraged.
2 CLASSIFYING DISTAL RADIUS FRACTURES AND NEW YARDSTICK TO ORTHOPAEDIC RESIDENTS, Younis kamal
Indian Journal of Orthopaedic Surgery (IJOS) is a peer-reviewed journal with reputable academics and experts as members of its Editorial Board. IJOS publishes information on basic and applied orthopaedics for a worldwide readership. It publishes original research papers, critical reviews dealing with all fields of Orthopaedics and it addresses the international scientific community. Papers related to orthopaedic science on a worldwide basis are also considered. Special emphasis is given to issues that go beyond the traditional boundaries of an orthopaedic journal. Articles on the state-of-the art of orthopaedic surgery in different parts of the world, the research activities and medical education in orthopaedic teaching, the role of orthopaedics in society, new findings from the frontiers of current research are always encouraged.
3 SYNOVIAL HEAMANGIOMA OF KNEE JOINT - CASE SERIES, Choudhari P, Chhabra S, Kiyawat V
Back ground: Haemangioma arising in the knee is a rare cause of knee swelling. The diagnosis frequently is delayed for long. Method- We are presenting the case series of 3 cases of synovial haemangioma of knee joint. All the three case presented to us with pain and swelling in the knee joint. Conclusion: The aim of presenting this case series is to create awareness about the possibility of a haemangioma arising from a joint which although rare should be kept as a differential diagnosis.
4 STUDY OF SURGICAL MANAGEMENT OF DISTAL FEMORAL FRACTURES BY DISTAL FEMORAL LOCKING COMPRESSION PLATE OSTEOSYNTHESIS, Ramesh Krishna. K, Manju Adithya Nayak B. S, G. Amrit
A prospective study of 30 patients with closed distal femur fractures (AO classification A, C) of both sexes & above 18 years of age managed surgically by Distal Femoral Locking Compression Plate with the aim of finding its efficacy in terms of union rate (time to union), time of mobilization, functional results, radiological results & complications over a period of 1 year. Minimum of 6 months & maximum of 16 months follow up was done. Patients were evaluated both clinically as well as radio logically at 6 weeks, 12 weeks, 6 months, 9 months & 12 months. Result of the study showed that the average time to union was 3.83 months. The average range of flexion obtained postoperatively was 111.30. Two contractures & decreased knee movements, four mal-alignment / mal-union, one implant failure & one infection were the residual complications in our study. Mean Neers score was 80.20. Excellent results were seen in 15 cases, satisfactory in 11, unsatisfactory in 3 & 1 case of failure was seen. So the results showed that Locking Compression Plate (LCP) system, is a safe & reliable implant for distal femur fractures AO types A & C.
5 WEDGE COMPRESSION OF LUMBAR SPINE ASSOCIATED WITH INGESTION OF ARTIFICIAL DENTURE. A VERY RARE ASSOCIATION, Hayat Ahmad Khan, Younis Kamal, Adil Bashir Shah, M Ashraf Khan, M Shahid Bhat, Naseemul Gani
Introduction: Spinal fractures are often seen in the accident and emergency department. These usually result from the Road traffic accidents in young or due to fall from height in elderly. These fractures are sometimes associated with other injuries as well. Artificial denture ingestion as associated with spine fracture is not been reported in literature. We present a case of elderly male patient who had such association and was picked up early and managed uneventfully. Case Presentation: Following fall from height, Patient was brought to us with pain back with difficulty to stand. Patient was initially stabilised and on examination he had tender neck and lumber spine. Foreign body was suspected on x rays besides a wedge compression fracture at L1. Patient was subjected to hypo laryngoscopy and artificial dentures were removed. Conclusion: This case highlights the need for looking artificial dentures by the emergency care physicians while dealing with the trauma patients. The history should be asked in elderly patients who turn up with fractures following fall to rule out any artificial teeth ingestion. Early diagnosis can prevent morbid complications.
6 ENIGMA OF THE DISTAL ULNAR FRACTURES: A RESEARCH TOWARDS THE SOLUTION, Mukesh Tiwari, Vikram Khanna
Forearm fracture are one of the common fractures ,although complete data are not present regarding epidemiology of forearm fractures but at some international centers forearm diaphysis fractures account for 5% of all fractures out of which most of the fractures are distal forearm fractures. In literature little stress is given over the management of distal ulna fracture. In our research we have divided distal ulna fracture in different categories like combined fracture with radius, acute ulnar styloid fracture, ulnar styloid with nonunion, ulnar neck fracture, fracture with commination. A systematic approach towards these fracture by using this classification can be helpful in management of these fracture.
7 CYSTICERCOSIS OF FOREARM: A RARE CASE REPORT, Mohammad Farid, Sanjiv Kumar, Atil Kumar lal, Sudhir Singh
Cysticercosis is a common human infestation in the developing world. Cysticercosis is an infection caused by the larvae of the tapeworm, Taenia solium. Neurocysticercosis is the most common clinical presentation of cysticercal infestation in the human body, but it may be rarely encountered in other body parts like skeletal muscle, subcutaneous tissue and eye. A 17 yr old female presented in the orthopedics department with complains of swelling over the right forearm since 4 months. It was diagnosed as a cysticercosis on MRI and ultrasonography of forearm and it revealed a scolex, the aim of this case report was to document a rare presentation of cysticercosis cyst in forearm. It was treated by albendazole 400mg for twice a day dose daily for 1 month. The patient came for follow up after 6 weeks and no swelling was palpable and MRI and USG reports did not reveal any cystic lesion..
8 EFFECT OF RADIOLOGICAL PARAMETERS ON FUNCTIONAL OUTCOME IN MANAGEMENT OF INTRA-ARTICULAR FRACTURES OF DISTAL END OF RADIUS A RETROSPECTIVE STUDY, Aradhana T. R., Ramesh Krishna. K, Preetham N.
Background/Purpose: Distal radius fractures are one of the most common injuries to the musculoskeletal system. Functional outcome in these fractures depend on many factors. Our main aim was to study if good radiological outcome has any effect on functional outcome. Methods: We retrospectively studied 80 patients, of which 53 were males & 27 females. 40 cases were treated with conservative management & 40 cases with surgical management. Results: Most of the patients were between 20-30 years (Mean 40.35 years). Most commonly the mode of injury, wrist involvement & fracture type were RTA (51.7%), Right side (53.3%) & Frykmans III (41.7%) respectively. Mean pain score & Function score (PRWE) and loss of movements were less among patients where radiological parameters were restored. Conclusion: From this study, we conclude that restoration of radiological parameters will help in good functional outcome in treatment of intra-articular fractures of distal end of radius.
9 AN EVALUATION OF TIBIA PLATEAU FRACTURE MANAGED SURGICALLY WITH BUTTRESS PLATE AND CANCELLOUS SCREWS, Avinash Jain, Jayant Sharma
Introduction: Injuries to the bones forming knee joint particularly tibial plateau fractures can result in functional impairment and also one of the most challenging to treat. Proximal tibia fractures constitute about 8% of all fractures in elderly. Improvements in surgical techniques and implants, has favoured a trend towards surgical managements, with objectives including precise reconstruction of the articular surfaces, stable fixation, early mobilization and repair of all ligamentous and soft tissue lesions1. However success of the surgical management needs revaluation. Materials and Methods: It is a prospective analytical study of 2 year duration. A total of 50 patients with tibial plateau fractures were selected and managed surgically. Results: In our study of 50 patients, 13 were managed by CRIF with PCCS, 37 were managed by ORIF with Buttress plate and Bone grafting. Post-operative assessment for an average period of 12.56 months done. And the results were analysed in terms of aetiology, sex ratio, age group, classification type, dominant side, complications like OA, knee stiffness, etc. Conclusion: The management protocol of tibial plateau fractures is challenging. Fracture type is the chief determinant for the choice of procedure. The aim is to achieve anatomical reduction and rigid fixation to restore articular congruity, facilitate early knee motion by reducing postoperative complications and thus achieving optimal knee function at the earliest. These fractures, still pose a challenge to the surgeon, they need to be evaluated, planned and treatment executed in the best of experienced hands.
10 A STUDY ON FUNCTIONAL OUTCOME OF SURGICAL MANAGEMENT OF INTRA ARTICULAR FRACTURES OF DISTAL HUMERUS IN ADULTS, Ramesh Krishna. K, Aradhana. T. R, Preetham. N
Background: Intra-articular distal humerus fractures comprise 1% of all fractures in adults1. Recent studies have emphasised the importance of surgical approach, rigid fixation and early rehabilitation for good outcome. Objectives: To assess the anatomical reduction of distal humeral articular surface by radiological examination and stability of the elbow by the functional assessment over a period of 1 year. Methodology: Thirty consecutive patients with distal humerus fractures were treated from October 2012 to October 2014 .The fractures were fixed using AO double column (orthogonal) plating techniques. Physiotherapy started from 3rd day post-op. Patients were followed at 6weeks, 3 months, 6 months, 1 year interval. Clinical outcome assessed using MEPI (Mayo Elbow Performance Index) score and radiologically assessed for reduction, alignment, fracture union, and complications. Results: All patients had completed postoperative physical therapy at the time of the study and had achieved maximum function of elbow. The mean duration of follow-up was 12 months. The mean arc of flexion was 106. Mean pronation was 76 and supination was 77. The mean MEPI score was 95.1 points (range 0 to 100 points), indicating mild impairment. Radiographic evidence of fracture union was noted in all patients. Conclusion: We conclude that internal fixation of intra-articular fractures of the distal humerus is an effective procedure with an excellent functional outcome in most patients. Patients have a high level of satisfaction and the majority return to their previous level of activity.
11 A COMPARATIVE STUDY OF OLECRANON OSTEOTOMY APPROACH AND TRICEPS REFLECTING APPROACH IN OSTEOSYNTHESIS OF DISTAL HUMERUS FRACTURE IN ADULTS, Ramesh Krishna. K, Aradhana. T. R, Preetham. N
Introduction: Olecranon osteotomy provides a good exposure of the fracture site for distal humerus fracture fixation. However, it is not without its potential disadvantages of delayed union, non-union at osteotomy site and other implant related complications. Triceps reflecting approaches are known to avoid these complications. The aim of our study was to compare the outcomes in the two surgical approaches by assessing the radiological union, the functional outcome by MEPI score and complications associated with each approaches. Methods: 40 consecutive patients were alternatively allotted into two groups. Group A had 20 patients treated surgically by trans-olecranon approach. Group B had 20 patients treated surgically by triceps reflecting approach. Patients were followed up for period of 24 months. Patients were assessed for stability of fixation, radiological union, the functional outcome using MEPI, and the complications in each group were reported. Results: Regardless of the fracture and implant type, functional mobility, elbow function, patient satisfaction, and quality-of-life assessments were comparable between the groups at three and twelve months. No significant differences were found in the functional outcome. But olecranon osteotomy approach group were associated with more complications Conclusion: Trans-olecranon and triceps reflecting approaches are similar in their functional outcomes but complication rates are higher in trans olecranon approach.
12 POST ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION INFECTION: REVIEW OF LITERATURE, Sanyam Chaurasia, Georgios Karnatzikos, Alberto Gobbi, Vivek Gupta
Purpose: The purpose of this study was to review and summarize the literature and suggest the probable most effective protocol in the management of post anterior cruciate ligament reconstruction (ACLR) infection. Methods: We reviewed 16 studies (Level 1- Level 4) published between January 2000 and December 2013, by a thorough search in PUBMED, MEDLINE and EMBASE databases. Results: There were 246 cases of infection amongst 35,795 ACLR making the proportion of infection 0.68% (range- 0.14-2.6%). The mean time of onset of infection from index surgery was between 7.5 days to 32 days. The most common organism was Coagulase-negative Staphylococci (CNS) followed by Staphylococcus Aureus. Optimal outcome was reported in most studies using serial arthroscopic lavage and intravenous antibiotics with graft retention as a prime protocol. Conclusion: Septic arthritis after ACLR is a rare and disastrous complication which can be successfully managed by early diagnosis and arthroscopic debridement with a proper protocol. Level of Evidence: Review Article; Level 4.
13 SYNOVIAL CHONDROMATOSIS OF KNEE: A CASE REPORT, Mohammad Farid, Kumar Satyendra, Lal Atil Kumar, Rai Tushar, Singh Sudhir
Synovial chondromatosis is a rare benign condition arising from the synovial membrane of the joints, synovial sheaths or bursa around the joints. The purpose of this case report is to document this condition in younger age group as compared to age group of 30-50 yrs where it has been seen relatively more commonly, and of attachment of multiple loose bodies to anterior cruciate ligament which was treated by arthroscopic synovectomy and removal of loose bodies was done in a 22 yr old male.
14 MANAGEMENT OF BONE DEFECT IN FOREARM BY CREATING ONE BONE FOREARM - A CASE REPORT, Ramesh Krishna K, Aradhana T R, Sreekantha K S, Preetham N
35 year old, housewife presented with non-union right forearm following crush injury right forearm thirteen months back. Extensor tendons were lost, fixed deformities were present at wrist and x-ray showed non-union with gap of radius more than ulna and wrist arthritis. Radialization of ulna was done creating one bone forearm with bone graft. Three months follow-up showed fracture union in progress, with good cosmetic appearance and some function of the right upper limb. One bone forearm procedure can be considered to treat post traumatic bone loss in forearm when other treatment fails.