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   Table of Contents - Current issue
July-December 2019
Volume 7 | Issue 2
Page Nos. 39-86

Online since Friday, December 13, 2019

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Refinement of the journal of orthopedics and allied sciences p. 39
Pradeep K Singh, Shraddha Singhania, Sohael Mohammed Khan
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Arthroscopic treatment of isolated type 2 SLAP lesions in athletes: A systematic review p. 40
Atul Mahajan, Dougulas Wong
Superior Labrum From Anterior to Posterior (SLAP) lesions refer to a tear of the superior portion of the glenoid labrum that begins posteriorly and extends anteriorly to the mid-glenoid notch. Patients who sustain traumatic injuries to the shoulder girdle and also who undergo repetitive, overhead motions are at risk for SLAP lesions. Among the various types of SLAP lesions, type 2 lesion is the most common lesion encountered and is defined by 'superior labral fraying with stripping of the superior part of the labrum and attached biceps tendon from the underlying glenoid cartilage”. In superior labrum anterior and posterior (SLAP) tears, a common concern for patients is being able to return to their previous levels of activity after surgery, whereas clinicians are concerned with providing a consistent prognosis of successful return to participation after surgery. Thus, return to play (RTP) and patient satisfaction can be used as a vital measure of treatment success which has been evaluated by significantly fewer studies, especially in isolated type 2 SLAP repairs. The published outcomes of surgical treatment are inconsistent, with variable and suboptimal patient satisfaction rates and RTP. Thus, we wanted to address and reevaluate the current treatment, rehabilitation protocols, and outcome following arthroscopic repairs in order to expand the knowledge and give further insight into providing better management plan in these patients. This study used a systematic review of papers reporting arthroscopic treatment of isolated type 2 SLAP lesions with the main objective in trying to assess the effectiveness of arthroscopic repair, to determine patient satisfaction and RTP at previous level of activity, and to analyze the rehabilitation protocols being followed among all athletes who underwent repair of type 2 SLAP tears using various types of fixation.
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Distal radius fractures with unstable distal radioulnar joint treated by volar plate: A comparative study of immobilization versus early mobilization p. 46
Subraya Bhat Kuloor, Abdul Jameel Shareef
BACKGROUND: Instability of distal radioulnar joint (DRUJ) following distal radius fracture is a treatment enigma with few options and uncertain outcome. Different studies have been conducted in this regard which came out with contradicting results. The aim of this study was to analyze whether immobilization of unstable DRUJ with above-elbow cast for 6 weeks has any advantages versus immobilization for 3 weeks similarly after anatomical fixation with volar plates. MATERIALS AND METHOD: We conducted a prospective study on patients with unstable distal radius fractures treated by open reduction with volar buttress plate from 2013 to 2016. Patients were grouped into Groups 1 and 2 depending on the postoperative immobilization protocol (each group with 21 patients). Group 1 patients were immobilized with above-elbow cast for 3 weeks and Group 2 patients for 6 weeks. Results were compared using wrist range of movements, patient-oriented Patient-Rated Wrist Evaluation (PRWE) and physician-based Sarmiento modified Gartland–Werley (GW) demerit scoring. All patients were evaluated for the persistence of DRUJ instability. RESULTS: Demographic data were comparable between the groups. AO type C fracture (67%) was common in both groups. The range of movements was comparable in both groups (P > 0.11). There was no statistically significant difference found in GW and PRWE scoring (P > 0.05). There were two patients with unstable DRUJ with decreased radial height and positive ulnar variance who needed further treatment. CONCLUSION: Prolonged immobilization (6 weeks) contributed no extra benefit when DRUJ is well reduced with anatomical fracture fixation. The instability recovered with healing of ligamentous injuries and fractures after stabilization of unstable bony fragments with surgical fixation of distal radius fracture.
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Use of biodegradable materials as local antimicrobial carriers in orthopedic infections p. 51
Antariksh Waghmare, Narendra K Saxena, Suvarn Gupta, Sohael Khan
INTRODUCTION: Orthopedic infections have been a major complication; despite numerous advances in prophylactic measures, infections still remain a major complication in orthopedic and trauma surgery. The progressive infection of the bone and the surrounding tissue results in bone infarcts with abscess and sequestrum formation. Adequate treatment can be an implant removal and a radical debridement with a long-term course of systemic antibiotic, but these prolonged therapies can result in side effects or toxicity. The primary reason for using local antibiotic delivery vehicles is its ability to achieve high local concentrations without associated systemic toxicity. MATERIALS AND METHODS: This is a prospective study conducted over 2 years. Thirty-five patients were studies in which 33 patients were managed with calcium sulfate + antibiotic, 1 was managed prophylactically with beads, and one was managed with Abgel + antibiotic as a biodegradable carrier. The aim was to evaluate the efficacy of biodegradable materials as antimicrobial carriers in localized orthopedic infection. OBSERVATIONS: A prospective study consists of 35 cases of orthopedic infections with major number of patients belonged to the age group of 20–40 years, with a mean 37.66 ± 19.9 years. One patient was included with soft tissue infection and rest all the patients had bone infections. It was observed that there is statistically significant improvement in ASEPSIS score at 0 week to ASEPSIS score at the end of 9 weeks. CONCLUSION: In the present study, the patients showed evidence of excellent control of infection and osseous repair, and further, none of the patients required follow-up. In our series, we have used calcium sulfate as a biodegradable antimicrobial carrier with appropriate antibiotics and achieved good-to-excellent results in local orthopedic infections.
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Obesity and osteoarthritis of the knee joint: Is leptin the missing link? p. 57
Obinna Henry Obiegbu, ID Nnakenyi, CU Ndukwu
BACKGROUND: Osteoarthritis (OA) involves a progressive degeneration of the articular cartilage, remodeling of the subchondral bone, and synovitis. It typically affects diarthrodial (synovial) joints including the knee joints. Obesity, which represents a body mass index (BMI) of ≥30, has been linked to OA of the knee joint. A biomechanical theory which infers that repetitive application of axial loading at the knee joint is the mechanism through which obesity causes OA has long been put forward. However, metabolic factors (adipokines) may yet be a link between OA and obesity. AIM AND OBJECTIVES: This study was performed to establish if there is a correlation between serum leptin and radiological severity of OA of the knee joint in obese individuals. MATERIALS AND METHODS: This was a prospective study carried out after ethical clearance was obtained from the hospital's ethical committee. Written informed consent was obtained from all prospectively recruited participants. Patients who met the inclusion criteria were selected by random sampling into either the obese or nonobese group based on their BMI. The patients were radiographically evaluated, and data were collected using a well-designed and structured pro forma. 5 ml of blood was collected from each patient for the analysis of serum leptin level. RESULTS: A total of 100 patients were included into this study. Fifty of these patients were obese (BMI ≥30), whereas the other fifty were nonobese (BMI <30). The peak age of the occurrence of knee OA was 61–70 years. The mean serum leptin level in obese patients was 20.11 ng/ml, as opposed to that in nonobese patients of 4.88 ng/ml. The radiological severity was analyzed, and there was a positive correlation between serum leptin level and radiological severity in OA of the knee joint. A higher percentage of females in this study were obese (71%) as opposed to males (29%), and females had statistically significantly higher leptin levels when compared to males. CONCLUSION AND RECOMMENDATION: From the results of this study, it is concluded that there is a correlation between serum leptin levels and radiological severity of OA of the knee joint in obese patients.
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Study on risk factors affecting nonunion of fractures p. 62
Giridharan Shanmugam, M Sivasubramanian, V Kabilan, S V Pavan Kumar, K Caroline Priya, Seenivasan Poikailawar
INTRODUCTION: Nonunion is one of the most common complications of fracture healing. The incidence of nonunion is believed to vary from 5% to 10%. AIM: The aim of the research is to study the risk factors affecting nonunion of fractures and analyze the treatment taken, and it is bearing on nonunion. MATERIALS AND METHODS: The study is a cross-sectional observational study with purposive sampling done in the orthopedic department. A total of 71 patients were selected, and a questionnaire was filled in with data obtained from the patient and medical records. Radiological evidence was also used to confirm the nonunion. RESULTS: The sample included 48 men and 23 women. Of the females, 21 had attained menopause (91%). About 58% of the patients had taken treatment from Traditional Bone Setters (TBS), and 49% of the patients first went to a TBS before coming to the allopathic physician for fracture treatment. About 45% of the patients had a very short duration of immobilization of their fractures. A history of previous malignancy, bone cyst, or other illnesses lead to a longer time for recovery and return to work (P = 0.0339). Patients who had infected fractures had a significantly more number of surgeries than those without infection (P = 0.015). Nonsteroidal anti-inflammatory drugs use during treatment of fracture was also associated with nonunion (P = 0.0077), especially in allopathic medicine. CONCLUSION: Nonunion continues to be a significant problem for all orthopedic surgeons despite their best ability to prevent them. A complete examination of the patient with relevant investigations and selection of the most suitable and appropriate treatment for each individual should be carried out; since each person is unique, and every fracture is not alike.
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Acute compartment syndrome of the foot: An unusual case caused by Graston technique p. 68
Vince W Lands, Ajith Malige, William L Delong
The purpose of this case report is to describe an unusual cause of compartment syndrome of the foot that developed subsequent to the use of Graston technique in a patient who had recently underwent revision total hip arthroplasty (THA). A 60-year-old female presented for orthopedic follow-up care in the office, 10 days postoperatively following an explant of her right hip Prostalac® spacer (DePuy) for previous infection and conversion to right THA (DePuy CORAIL® Hip System) complaining of severe right foot pain, swelling with pressure in foot, paresthesia, and inability to bear weight. The patient had undergone Graston technique for bilateral foot swelling by her home physical therapist. The patient was clinically diagnosed with acute compartment syndrome (ACS) of her right foot and underwent intervention. The treatment consisted of acute fasciotomy of her right foot with vacuum-assisted closure application. Delayed closure was initiated once soft-tissue decompression occurred. Due to acute fasciotomy, ambulation was inhibited and physical therapy delayed. The postoperative course was uneventful following the release of tense compartments, weight bearing was resumed once incisions healed, and the patient was pain free while deep-venous thrombus prophylaxis was continued. No further issues occurred postoperatively, and the patient showed overall clinical improvement. Residual soft swelling can be expected following hip surgery, especially at the caudal end of limbs. Immobilization enhances this engorgement. However, due to the aggressive Graston technique performed by the therapist, the patient developed ACS of the foot. Graston technique has been documented to increase blood flow to treated areas. Early and aggressive intervention should be initiated if ACS is clinically or objectively found, as late detection may have disastrous results.
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Multifocal intraarticular lipoma arborescens of the hip and knee: A case report and review of literature p. 72
Atul Mahajan, Seung Han Beom
Lipoma arborescens (LA) is a rare clinical condition presenting mostly as an intra-articular lesion characterized by villous proliferation of the synovial membrane and hyperplasia of sub synovial fat. We report a case of a multifocal LA localized in the knees and the hips in a 20-year-old man symptoms being present for the last 3 years and initially mimicking an inflammatory arthropathy. On physical examination a discreet joint swelling of the left knee with effusion, and limited movements in the left hip were observed. Laboratory tests presented normal acute phase reactants of inflammation as well as the rheumatoid factor, CK, and negative results for antinuclear and anti-CCP (ELISA) antibodies. Magnetic resonance imaging of the knees and hips showed articular effusion and synovitis, and a pattern of LA. The histopathologic study confirmed the diagnosis. Arthroscopic synovectomy for the knee and open synovectomy for the hip brought some improvement to joint mobility and pain.Although rare, this condition must be differentiated from inflammatory arthropathy, particularly in the absence of response to clinical treatment, and absence of positive biochemical markers, since the therapeutic strategy is radically different.
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A rare case report of osteomyelitis of myositis ossificans traumatica mass in leg p. 76
I Ibad Sha, Ajin Edwin, Syam Roy
Myositis ossificans traumatica is a non-neoplastic proliferation of bone and cartilage tissue at the site of a previous injury. Osteomylitis of Myositis Ossificans Traumatica mass is even rarer and literature review show that this is only the second case reported till now. A 61 years old male presented to our outpatient department with main complaints of discharging sinus left leg for 7 months. Clinical provisional diagnosis of chronic osteomyelitis of left leg was made. Standard radiograph shows a large mass around the middle and lower third of left leg with osteomyelitic changes in the lower third. Magnetic Resonance Imaging confirm the diagnosis as Infectious Myositis mass. The patient got operated with complete excision of myositis mass and infected tissue. Post operative follow up shows complete healing with no recurrence. Osteomyelitis of myositis ossificans can be a possible differential diagnosis of chronic discharging sinus in cases were there is associated myositis mass adjacent to the lesion. Prompt diagnosis along with excision removal of mass and infected tissue should be the treatment to avoid recurrence.
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Noncontiguous two levels traumatic dislocation of the cervical spine managed with a posterior only approach p. 80
Amit Agrawal, V A Kiran Kumar, N A Sai Kiran, M Venkatesh, V Anil Kumar
Literature defines multiple noncontiguous vertebral injuries, as “injuries to the vertebral column involving ≥1 site, and these injuries are separated by an apparently normal area of the spine.” In the present article, we report an unusual case of two nonadjacent levels traumatic dislocation, involving the cervical spine managed through the posterior-only approach.
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Virtual reality applications in orthopaedics Highly accessed article p. 83
Abid Haleem, Mohd Javaid, Raju Vaishya, Ibrahim Haleem Khan
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Dr Ketan Khurjekar (1975–2019) p. 85
Gururaj Sangondimath
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