Journal of Orthopedics and Joint Surgery

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Volume 6, Number 1, January-June 2024
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EDITOR IN CHIEFS MESSAGE

A Suresh Kumar, TR Ashok

Editor-in-Chief's Message

[Year:2024] [Month:January-June] [Volume:6] [Number:1] [Pages:1] [Pages No:iv - iv]

   DOI: 10.5005/jojs-6-1-iv  |  Open Access | 

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President's Message

V Singaravadivelu

President's Message

[Year:2024] [Month:January-June] [Volume:6] [Number:1] [Pages:1] [Pages No:v - v]

   DOI: 10.5005/jojs-6-1-v  |  Open Access | 

55

Secretary's Message

Secretary's Message

[Year:2024] [Month:January-June] [Volume:6] [Number:1] [Pages:1] [Pages No:vi - vi]

   DOI: 10.5005/jojs-6-1-vi  |  Open Access | 

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ORIGINAL RESEARCH ARTICLE

Sivakumar Raju, Sudeep K Velur Nagendra, Vinoth Thangamani, Bharat K Ramalingam Jeyashankaran, D Abinav Annamalai

A Study of Functional and Radiological Outcome in Anterior Cervical Discectomy and Fusion with Stabilization in Posttraumatic Acute Central Cord Syndrome

[Year:2024] [Month:January-June] [Volume:6] [Number:1] [Pages:11] [Pages No:1 - 11]

Keywords: Anterior cervical discectomy and fusion, American Spinal Injury Association score, Bridwell score, Central cord syndrome, Cervical spine injury, Modified Japanese Orthopedic Association score, Visual analog score

   DOI: 10.5005/jojs-10079-1135  |  Open Access |  How to cite  | 

Abstract

Background: Spinal injuries account for around 6% of overall trauma patients, of which cervical spine injuries contribute >50%. Central cord syndrome (CCS) is the most common subtype of incomplete spinal cord and accounts for around 15–25% of all cases. The aim of this study is to assess the functional and radiological outcomes of posttraumatic acute CCS treated with anterior cervical discectomy and fusion (ACDF) with stabilization. Materials and methods: It is a prospective study done between October 2020 and September 2022 in the Department of Orthopaedics, Preethi Hospital. Our study consists of 23 patients with posttraumatic CCS treated with ACDF with stabilization. Neurological and functional outcomes were assessed using the modified Japanese Orthopedic Association (mJOA) scale, visual analog score (VAS), and American Spinal Injury Association (ASIA) score at regular intervals of 3 and 6 months and 1 and 2 years, respectively. Results: Our study population comprised 19 males and four females with posttraumatic acute CCS. The average follow-up was 12–24 months. Out of 23 patients, 13 had single-level fusion, and 10 patients had double-level fusion surgery. In our study, preoperative (pre-op) mean VAS decreased from 7.6 ± 0.84 to 6.9 ± 1.6 postoperatively, and the mean mJOA score decreased from 8.2 ± 2.2 to 14.5 ± 2.0 postoperatively were statistically significant. On comparing pre-op and postoperative ASIA neurological grading, statistically significant improvement of ASIA grades. Radiological outcomes according to Bridwell's fusion criteria in computer tomography (CT) were also excellent. Conclusion: To conclude, we recommended surgical decompression with ACDF as the current mode of treatment with excellent functional and radiological outcomes with long-term results for posttraumatic CCS.

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ORIGINAL RESEARCH ARTICLE

Anupam Gupta, C Prasanna, BK DinakarRai

Prediction of Nonunion in the Diaphyseal Segment of Long Bones in Adults Using the RUST Score and Modified RUST Score

[Year:2024] [Month:January-June] [Volume:6] [Number:1] [Pages:5] [Pages No:12 - 16]

Keywords: Diaphyseal segment, Modified radiographic union score for tibia, Nonunion, Radiographic union score for tibia

   DOI: 10.5005/jojs-10079-1126  |  Open Access |  How to cite  | 

Abstract

Background: The study analyzed the radiographic union score for tibia (RUST) and modified radiographic union score for tibia (mRUST), a time-based scoring system for categorizing delayed union and nonunion, to assess 3-month fracture healing in the diaphyseal segment of long bones. Delayed union patients were treated with bone marrow or platelet-rich plasma injections and dynamization to reduce the rate of nonunion. Materials and methods: In this study, randomized patients were prospectively analyzed by RUST and modified RUST scores after internal fixation of tibial, humeral, and femoral fractures (AO/OTA tibia 42A, femur 32A, and humerus 12A). The aim was to define delayed union or nonunion based on the scoring system and time factor. The delayed union patients were offered simple secondary interventions. Patients at risk of nonunion were identified. Results: Out of 64 patients, only 48 patients completed regular follow-ups. The rate of nonunion was 6.25. The mean score of 5.33–5.67 at 3 months was consistent with those in previously published works on the tibia and femur. The 3-month mRUST score for humeral fractures had no predictive value. Conclusion: Lower 3-month RUST scores for tibial and femoral fractures are strongly associated with nonunion, and there is a need for secondary intervention. However, lower modified RUST scores for humeral fractures at 3 months had no prognostic value for detecting nonunion.

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ORIGINAL RESEARCH ARTICLE

Suresh Perumal

Prevalence of Glenohumeral Internal Rotation Deficit in Fast Bowlers and Its Correlation with Bowling Speed

[Year:2024] [Month:January-June] [Volume:6] [Number:1] [Pages:3] [Pages No:17 - 19]

Keywords: Bowling speed, Fast bowling, Glenohumeral internal rotation deficit, Injuries, Shoulder

   DOI: 10.5005/jojs-10079-1125  |  Open Access |  How to cite  | 

Abstract

Background: Glenohumeral internal rotation deficit (GIRD) is a common musculoskeletal disorder seen in overhead athletes due to repetitive overhead activity at extreme ranges of motion. This causes capsuloligamentous and muscular microtrauma, leading to anterior capsule overstretching along with the posterior band of the inferior glenohumeral ligament (IGHL) and posterior capsular contracture. This is a performance adaptation to achieve greater ball speeds. Cricket fast bowling also involves a high workload of repetitive shoulder activity to propel the ball at faster speeds. Despite adequate literature on other overhead and throwing sports, there is a lack of literature on the prevalence of GIRD in fast bowling. Objectives: The present study aims to estimate GIRD prevalence in Indian cricketers and investigate its relationship with bowling speed. Materials and methods: Shoulder range of motion was assessed for 22 top-division-level male cricket bowlers in their dominant and nondominant sides, and the GIRD was estimated. Bowling speed was measured with a radar gun. Pearson correlation was used to evaluate the relationship between shoulder range of movement and bowling speed. Results: None of the bowlers in this study fit the diagnostic criteria for GIRD. The average loss of internal rotation was 5.68 ± 4.44°. Loss of internal rotation (IR) and bowling speed showed no correlation (coefficient 0.1671, p-value 0.45). Conclusion: The sampled fast bowlers did not show features of GIRD, and there was no correlation with bowling speed. This could be explained by the large difference in the biomechanics of bowling compared to throwing and that bowling speed is also determined by various other factors such as run-up velocity, lower body kinetics, kinematics, etc. Clinical significance: This information is valuable to sports medicine doctors and coaches, providing a better understanding of shoulder biomechanics in fast bowlers and its relationship with bowling speed.

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ORIGINAL RESEARCH ARTICLE

Prahalad Kumar Singhi, Sivakumar Raju, Chidambaram Muthu, Gopi Kumarasamy, Vinoth Thangamani, MuthuKishore Marichamy

Intra-articular Glenoid Fracture Managed by Arthroscopic Fixation and Open Reduction and Internal Fixation Techniques: An Analytical Study

[Year:2024] [Month:January-June] [Volume:6] [Number:1] [Pages:7] [Pages No:20 - 26]

Keywords: Arthroscopic fixation, Intra-articular glenoid fracture, Open reduction and internal fixation, Treatment algorithm

   DOI: 10.5005/jojs-10079-1129  |  Open Access |  How to cite  | 

Abstract

Introduction: Intra-articular glenoid fractures are rare injuries. Due to complex anatomy and neurovascular structures in vicinity, operative treatment is relatively uncommon. With the advent of three-dimensional (3D) computed tomography (CT), appropriate analysis of fracture pattern and management protocols can be developed. Operative treatment has evolved from extensive open reduction to arthroscopic surgery. Here, we analyzed the intra-articular glenoid fractures, which were managed by conservative, open, or arthroscopic fixation (ARIF) to derive a treatment algorithm. Materials and methods: All the shoulder fractures which presented to our hospital from January 2018 to December 2020 were screened for intra-articular glenoid fractures. An institutional treatment algorithm was followed for 10 such fractures, where four underwent ARIF, four by open reduction, and two were conserved. These patients were followed up, and functional evaluation with Constant–Murley and the University of California, Los Angeles (UCLA) scoring system were done. Results and discussion: The mean constant score at 1 and 2 years follow-up were 63.2 ± 9.3 and 78 ± 9.7, respectively. The mean UCLA score at 1 and 2 years follow-up were 23.7 ± 4.4 and 28.3 ± 3.7, respectively. At the end of 2 years’ follow-up, all these patients had good to excellent outcome. One patient had shoulder stiffness; clavicle elastic nail was removed in two cases as it caused irritation at entry site and no other major complications. Conclusion: Intra-articular glenoid fractures are uncommon injuries but can end up in severe morbidity if neglected or not aptly treated. Anatomical restoration of the articular surface is the goal in management of intra-articular glenoid fractures. Undisplaced fractures or articular step-off <2 mm can be managed conservatively. Even the undisplaced glenoid fracture needs fixation if there is a double disruption of scapulothoracic suspensory complex (SSSC). Displaced intra-articular fractures without extending into scapular body and double disruption of SSSC can be managed with ARIF. Intra-articular glenoid fracture extending to scapular body or double disruption of SSSC warrants open surgery. Clinical significance: We report a single-center study with treatment algorithm for surgical management and decision-making in intra-articular glenoid fractures, which remains challenging.

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ORIGINAL RESEARCH ARTICLE

Vidya S Konana, Harish S Yallapura, Sriharsha Bettaswamy, Srinivas P Sivaram, Darshan G Thimmegowda

Comparing the Effectiveness of Intra-articular Injection with Autologous Platelet-rich Plasma vs Hyaluronic Acid vs Platelet-derived Growth Factors in Early Osteoarthritis of Knee Joint

[Year:2024] [Month:January-June] [Volume:6] [Number:1] [Pages:8] [Pages No:27 - 34]

Keywords: Hyaluronic acid, Intra-articular injections, Knee, Osteoarthritis, Platelet-rich plasma-derived growth factor, Platelet-rich plasma

   DOI: 10.5005/jojs-10079-1134  |  Open Access |  How to cite  | 

Abstract

Aims: To compare the effectiveness between intra-articular injection (IAI) of autologous platelet-rich plasma (PRP) vs hyaluronic acid (HA) vs activated PRP in primary osteoarthritis (OA) of the knee grades 1 and 2, in terms of pre- and postinjection functional outcome by the Western Ontario and McMaster Universities Arthritis Index (WOMAC) scale, and pre- and postinjection pain by visual analog scale (VAS). Materials and methods: The patients were divided into three groups based on the treatment they received. Group I received an HA injection of 25 mg, group II received an autologous PRP injection, and group III received an activated autologous PRP injection. The patients were evaluated primarily with WOMAC scale improvement and secondarily by VAS at the time of getting the injection (0), at the end of 1 month, and at the end of 3 months. Results: A total of 71 candidates were finally included in the study. Patients’ mean age of HA, PRP, and activated PRP was 54.5 ± 6.79, 55.47 ± 6.31, and 55.73 ± 7.33, respectively. In the HA group, the total WOMAC index decreased from 42.95 ± 3.49 to 21.29 ± 21.29, from 41.52 ± 4.17 to 18.91 ± 1.4 in the PRP group, and from 43.82 ± 4.67 to 18.91 ± 2.44 in the activated PRP group after 3 months (p-value is significant). Regarding the VAS scale, it significantly decreased after 3 months in the activated PRP group compared to others. Conclusion: The data revealed significant improvements in the WOMAC scale and VAS in all the groups at the 1- and 3-month follow-up visits. When comparing the change of WOMAC Scale and VAS at 1- and 3-month follow-ups, significant differences were found between the PRP and HA group and the activated PRP group, with activated PRP showing better outcomes compared to others.

93

ORIGINAL RESEARCH ARTICLE

Bharath Sekar, Jeganathan Parthiban, Sanjay Ayyakkannu Kasthuri Ranganathan, Suresh Perumal

Outcomes of Arthroscopic Posterior Capsulolabral Repair in Patients with Traumatic Recurrent Posterior Instability of Shoulder

[Year:2024] [Month:January-June] [Volume:6] [Number:1] [Pages:4] [Pages No:35 - 38]

Keywords: Arthroscopic intervention, Labral repair, Posterior shoulder instability

   DOI: 10.5005/jojs-10079-1139  |  Open Access |  How to cite  | 

Abstract

Introduction: Recurrent posterior subluxation is most frequently caused by microtrauma to the posterior capsulolabral shoulder complex. Patients with posterior shoulder instability typically have agonizing discomfort and weakness around the shoulder joint. Aim: To evaluate the outcomes of arthroscopic posterior labral repair in a patient with traumatic recurrent posterior shoulder dislocation. Materials and methods: Our study was conducted among 39 participants with traumatic posterior instability and assessed with UCLA, ROWE, QuickDASH, and Constant–Murley scores both preoperatively (pre-op) and after arthroscopic stabilization. Patients were followed up for 6 months and 1 year. Results: The mean and standard deviation (SD) age was 35.34 ± 4.72. The mean scores from UCLA, ROWE, QuickDASH, and Constant–Murley scores were improved and found to be better after an arthroscopic intervention. QuickDASH and Constant–Murley scores were found to be significant. Conclusion: In our study, we found that arthroscopic posterior shoulder stabilization produces excellent clinical results, high levels of patient satisfaction, and few complications.

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CASE SERIES

Muthamilselvan Kumanan, Manikandan Navaneethakrishnapandian, Mohamed Ibrahim

Effect of Synthetic Bone Graft Substitutes in Management of Nonunion in Long Bones: A Case Series

[Year:2024] [Month:January-June] [Volume:6] [Number:1] [Pages:5] [Pages No:39 - 43]

Keywords: Case report, Bone graft substitutes, Calcium sulfate, Calcium triphosphate, Synthetic bone graft substitutes

   DOI: 10.5005/jojs-10079-1130  |  Open Access |  How to cite  | 

Abstract

Introduction: Treating nonunion is a major concern for any orthopedic surgeon. Preparation of autograft for use in nonunion itself is associated with various complications, starting from donor site morbidities to postoperative wound infections. To overcome these complications, an artificial substance that is biocompatible, which mimics all the properties of an autograft, may be an ideal thing for the management of nonunion. One such thing that was put forth in our study is ”Synthetic Bone Graft.” All the pros and cons and their effectiveness in today's modern orthopedic management of nonunion are discussed below. Aim: To evaluate the efficacy and outcome of synthetic bone grafting substances in the management of nonunion in long bones. Materials and methods: This is a cross-sectional study. Patients with noninfected nonunion are selected. A total of 20 patients were treated with specific fracture fixation augmented with synthetic bone grafts and were followed for about 18 months in the Department of Orthopaedics, Tirunelveli Medical College Hospital, Tirunelveli, Tamil Nadu, India. Results and discussion: In our study of 20 cases with nonunion of long bones, 90% of cases (18 cases out of 20 cases) showed clinical and radiological union among our case study. A bone substitute with the composition of tricalcium phosphate and calcium sulfate is used in our study. Functional and radiological outcomes of synthetic bone graft materials in the management of nonunion in long bones showed far better results compared to other bone graft materials. In the future, the use of these synthetic bone graft materials in bone regeneration under specific indications and with safety roles will simulate the normal bone formation cascade with reduced morbidity and cost in the long-term.

71

CASE SERIES

Nishaanth Ragavan, Rex Chandrabose

Is Lateral Ligament Complex Repair Necessary in All Unstable Elbow Injuries with Coronoid Fractures? A Comparative Study: A Case Series

[Year:2024] [Month:January-June] [Volume:6] [Number:1] [Pages:5] [Pages No:44 - 48]

Keywords: Capitellum, Case report, Closed/open reduction, Radial head dislocation

   DOI: 10.5005/jojs-10079-1132  |  Open Access |  How to cite  | 

Abstract

Background: Unstable elbow injuries result in persistent discomfort, recurring instability, stiffness, and arthritis. The coronoid is prone to fracture as a result of axial stress and it serves as an anterior buttress that prevents the posterior ulna translation. In order to restore the bone and ligamentous components and allow for early mobilization, the protocol was formulated. Unfortunately, there was no clear idea regarding the surgical approach and essential structures to be restored for adequate elbow stability. Hence, our study was conducted to find out the appropriate structures and approaches to provide elbow stability and better functional outcomes. Materials and methods: A total of 28 patients (20 men and eight women) who had closed elbow dislocation with associated coronoid fracture and lateral ligament complex injury were studied prospectively. The patients were divided into two groups, group I included patients who underwent only coronoid fixation, and group II included patients who underwent both coronoid fixation with lateral ligament complex repair. In group II, the lateral collateral ligament complex was repaired only when the lateral approach was used in case of radial head fixation, radial head replacement, or excision. Wrightington's classification describes the cross-sectional findings in complex elbow fracture-dislocation injury was used. Magnetic resonance imaging (MRI) with computed tomography (CT) evaluation was done in all cases to assess the osseous and ligamentous status to select the appropriate surgical approach and method of fixation. Functional outcome was assessed using the Mayo Elbow Performance Score (MEPS) at 6 weeks, 3rd, 6th months, 1, and 2 years. Results: All patients in our study were treated surgically according to Wrightington's classification. Treatment is done as follows—coronoid process fixation with suture anchors, mini plate, and screws by medial Hotchkiss approach or modified anterior approach. Radial head fractures by fixation, excision, or radial head replacement. Associated olecranon fractures were fixed with locking compression plate (LCP) or tension band wiring. Functional outcome analyzed using MEPS shows excellent in 18 patients, good in nine patients, and fair in one patient. Conclusion: Not all patients with unstable elbow injuries need to follow the standard protocol for fixation. Restoring the elbow integrity with the appropriate method of fixation and approach is sufficient to provide a functional and stable elbow.

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CASE SERIES

R Sahaya Jose, N Kattu Bava, M Syed Moosa

Is Intra-articular Platelet-rich Plasma Injection Safe and Effective in Osteoarthritis Knee? A Prospective Study: A Case Series

[Year:2024] [Month:January-June] [Volume:6] [Number:1] [Pages:6] [Pages No:49 - 54]

Keywords: Case report, Kellgren–Lawrence grading, Knee osteoarthritis, Platelet-rich plasma, Visual analog score, Western Ontario and McMaster Universities Arthritis Index score

   DOI: 10.5005/jojs-10079-1131  |  Open Access |  How to cite  | 

Abstract

Background: Osteoarthritis (OA) of the knee is the most common slowly progressive chronic degenerative joint disease, characterized by varying degrees of loss of joint cartilage with local inflammation, usually affecting the elderly population. If oral drugs are ineffective, intra-articular injections (corticosteroids, viscous supplements, and blood-derived products) can be offered as another nonoperative modality. The release of platelet-derived factors directly at the site of cartilage disease, particularly with interest to knee OA, may stimulate the natural regenerative signaling cascade and enhance tissue healing with further mediation of the anti-inflammatory response. Suppression of mediators, such as interleukin-1 interaction with nociceptors, brings inflammatory and analgesic effects. Subjects and methods: This prospective study was conducted in our institution's outpatient orthopedics department from March 2022 to May 2023. In total, 30 patients of either sex, between 40 and 70 years of age, suffering from primary knee OA with Kellgren–Lawrence (KL) grades I, II, or III on standing anteroposterior and lateral knee radiographs, with symptoms for >3 months according to the American College of Rheumatology (ACR) clinical classification criteria and pain score of >4 cm on 10 cm visual analog scale (VAS) was included. We excluded patients below 40 and above 70 years of age with septic arthritis, grade IV OA according to KL grading, and systemic infections. Injected platelet-rich plasma (PRP) injection in the knee using an anterolateral approach. The patients were followed up for 6 weeks, 3 months, and 6 months using VAS, Western Ontario, and the McMaster University Osteoarthritis Index (WOMAC) scoring system. The data collected were subjected to data entry in Microsoft (MS) Excel. The data were analyzed using the Chi-squared test using the Statistical Package for the Social Sciences (SPSS) (SPSS Inc. IBM Chicago city, Illinois state, United States of America) version 20.0. Results: We have excellent improvement in VAS score from the mean value of 7.5 ± 2 initially at preinjection to 4.5 ± 1.5 after 6 months follow-up and WOMAC score from 74.5 ± 8.5 initially at preinjection to 55.5 ± 10.5 after 6 months follow-up. Conclusion: Based on our results, this minimally invasive PRP injection to the knee joint is a safe and effective treatment in mild to moderate OA. Since PRP injection is biologically considered to induce the growth of degenerated articular cartilage, it will be more effective in relatively young patients and lower degrees of cartilage degeneration. Since no complications were seen in this study, it is safe and effective to use PRP injection intra-articularly in grades I, II, and III OA of the knee joint. Clinical significance: Identifying the patients early with grades I, II, and grade III OA knee and treating them with intra-articular PRP injection shall delay the progression and the need for future total knee replacement surgery.

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CASE SERIES

Makesh Ram Sriraghavan, Poornima Kumararaja, Balakannan Jeyabalan

Assessment of Clavicular Shortening in Displaced Midshaft Clavicular Fractures Treated by Nonoperative Method, Plating, and Elastic Nailing: Comparative Functional Analysis'A Case Series

[Year:2024] [Month:January-June] [Volume:6] [Number:1] [Pages:6] [Pages No:55 - 60]

Keywords: Case report, Clavicle fracture, Constant–Murley score, Elastic nail, Functional outcome, Nonoperative method

   DOI: 10.5005/jojs-10079-1133  |  Open Access |  How to cite  | 

Abstract

Introduction: Clavicular shortening can occur after midshaft clavicular fractures, and its impact on functional outcomes has been a subject of interest in orthopedic research. Some studies have reported that clavicular shortening is associated with worse functional effects, while others have not found a significant correlation. Our series aims to equate the outcomes between nonoperative management and surgical interventions using two different techniques—plating and elastic nailing. Materials and methods: A cohort of 60 patients with displaced middle-third fracture of clavicle managed by three procedures—nonoperative, elastic nailing, and plating each of 20 cases, respectively were reviewed after a mean follow-up of 2 years. The primary outcome variables were assessed. Results: The mean shortening observed was 1 ± 0.75 cm. Patients with clavicular length shortening of >2 cm had distinct differences in their clinical outcomes compared to patients with less severe shortening (<1 cm), as it's associated with discomfort or pain, which can negatively impact a patient's quality of life and functional ability. Severe shortening, greater than 2 cm, can result in functional impairment similar to nonunion. Those cases operated by elastic nailing have shortening of <0.5 mm, with plating of <0.75 cm. Conclusion: When the clavicle is shortened, it can alter the balance of muscles and ligaments around the shoulder joint, leading to functional impairment. The treatment choice is not solely based on fracture configuration but also considers other factors, including the patient's age, activity level, and the surgeon's judgment. There can be variations in the threshold for surgery among different surgeons and institutions. Elastic nailing to be used in displaced midshaft fractures and comminuted fractures plating is the ideal choice.

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CASE SERIES

Karthik Chithartha, Vanasekar Mokkasamy

Outcome of Management of Midshaft Clavicular Fractures with Titanium Elastic Nail System: A Case Series

[Year:2024] [Month:January-June] [Volume:6] [Number:1] [Pages:4] [Pages No:61 - 64]

Keywords: Case report, Clavicle fracture, Clavicle shortening, Constant score, Displaced clavicle, Elastic nail, Intramedullary nail, Midshaft clavicle, Minimally invasive, Titanium elastic nail system

   DOI: 10.5005/jojs-10079-1137  |  Open Access |  How to cite  | 

Abstract

Introduction: The management of displaced midshaft clavicular fractures (MSCFs) is still a constant debate, and the current trend toward minimally invasive osteosynthesis has led us to study this technique and the outcome of stabilization using the titanium elastic nail system (TENS). Materials and methods: A total of 15 patients with fractures of the midshaft of the clavicle managed with TENS were included in the study from January 2018 to December 2022. Intraoperatively, TENS nail was applied for 11 cases with closed reduction, whereas four cases went on to have open reduction. All patients were followed for a minimum of 6 months postoperatively (post-op) with radiographs and functional score assessment. Result: The average age of the study population was 38.8 ± 11 years. Eight patients had AO type A fracture, five patients with type B, and two patients with type C fracture. Clinical assessment of the patients was done after radiological union using the constant shoulder score. The clinical union was attained in 4–7 weeks, while the radiographic union was attained in 6–9 weeks. In this study, we noticed that patients with type C fracture took longer for fracture union and mild medial migration of nails at final follow-up, requiring implant exit after fracture union. Conclusion: Surgical stabilization with TENS showed better results for patients with type A and B midclavicular fractures with respect to early functional recovery, minimally invasive, less operative time, and early mobilization. Clinical significance: Since the outcome of managing simple displaced MSCs using TENS is relatively excellent according to our study, TENS can be used to manage type A and B MSC fractures since it is easily available, less invasive, leaves a smaller scar, and has a faster recovery.

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CLINICAL TECHNIQUE

Baskar Chockalingam

Role of Joshi's External Stabilization System Fixator in Proximal Humerus Fractures

[Year:2024] [Month:January-June] [Volume:6] [Number:1] [Pages:4] [Pages No:65 - 68]

Keywords: Joshi's external stabilization system, Murley score, Proximal humerus fracture

   DOI: 10.5005/jojs-10079-1140  |  Open Access |  How to cite  | 

Abstract

Background: Proximal humerus fracture (PHF) contributes 4–5% of fractures that are bimodal in distribution. The most common etiology includes accidental falls in elderly population and road traffic accident (RTA) in younger population. There is a wide range of treatments starting from conservative to advanced techniques like replacement. The outcome depends on various factors like mode of treatment, age of the patient, anatomy of fracture, and associated pathological conditions. In this study, we justify how Joshi's external stabilization system (JESS) method scores over other methods of fixation. Material and methods: This study includes 42 patients aged between 19 and 88, out of which 24 were females and 18 males. All surgeries were done between 2019 and 2022 under regional block. Fractures are classified according to Neer's classification. All patients were followed up regularly and assessment was done based on both functional and radiological improvement. Results: The total number of cases was 42. The number of patients aged above 45 years was 29 and <45 years were 13. Out of the 42 cases, 24 cases were due to RTA. Based on Neer's classification, Neer type I, II, IV, and head split cases were 13, 16, 11, and 2, respectively. The outcome was assessed based on constant score. Two cases progressed to nonunion and four cases underwent premature removal due to various reasons. Finally, 66% of the cases showed excellent outcomes. Discussion: Proximal humerus fractures (PHF) have always been a challenge for orthopedic surgeons and remain controversial. As we mentioned earlier here, one of the main factors deciding the outcome is mode of fixation. JESS has the advantage of rigid fixation, early mobilization, and no loosening. JESS stands superior to plating and K-wires in this aspect. Hence, JESS fixation in PHF is a wonderful and viable option for fixation method irrespective of the age and fracture pattern.

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CLINICAL TECHNIQUE

Ramesh Perumal, Harish Mahesan, Dheenadhayalan Jayaramaraju, Rajasekaran Shanmuganathan

An Innovation to Address the Anterior Pelvic Ring Disruptions

[Year:2024] [Month:January-June] [Volume:6] [Number:1] [Pages:5] [Pages No:69 - 73]

Keywords: Anterior ring fixation, Diastasis, Pelvic injury, Pelvic ring disruption, Pubic symphysis

   DOI: 10.5005/jojs-10079-1127  |  Open Access |  How to cite  | 

Abstract

Background: Disrupted anterior pelvic ring injury most often requires plate fixation to achieve stability of the injury pelvic ring. However, there is relatively high incidence of hardware failure either in the early or late follow-up. Many of them require revision surgery if they become symptomatic in the early phase. Most commonly preferred fixation mode is plating, contoured 3.5 Matta plate, 3.5 reconstruction plates, and it may be single or dual. The purpose of this study is to report a case series of patients with disrupted anterior pelvic ring fixed with 4.5 dynamic compression plate (DCP). We innovated a technique in modifying the profile of the plate and contouring before it is applied over the superior surface of pubic symphysis. Materials and methods: A total of 21 patients between 2015 and 2018 with disrupted pelvic ring injuries for which open reduction and 4.5 DCP fixation are included in the study and classified according to Young–Burgess. All are evaluated as per advanced trauma life support (ATLS) protocol, and appropriate X-rays and computed tomography (CT) scans are taken. Hemodynamically unstable are stabilized with external fixator as a damage control procedure and planned for plating as a secondary procedure. Postoperative X-rays included AP, inlet, outlet, and lateral views and were reviewed at 4 and 12 weeks and 6 and 12 months for the evidence of loss of reduction, loosening of screws, hardware failure, and functional outcome (Majeed score). Three patients were lost to follow-up; hence, 18 are available for radiological and functional outcome. Results: Six patients showed evidence of early loss of reduction and screw loosening. However, none of the patients are symptomatic, which requires a revision surgery to restore the ring. There is no difference in the functional outcome between the early loss of reduction and the others. Conclusion: Modified 4.5 DCP fixation for the anterior ring fixation has shown excellent outcomes in disrupted pelvic ring injuries. It has no hardware failure, and six patients with loosening of the screws were asymptomatic and had good functional outcomes.

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CLINICAL TECHNIQUE

Kingsly Paulraj, Muthu Sathish

Strategies in Management of Posterosuperior Wall Fracture of the Acetabulum

[Year:2024] [Month:January-June] [Volume:6] [Number:1] [Pages:5] [Pages No:74 - 78]

Keywords: Acetabular fracture, Internal fixation, Kocher–Langenbeck approach, Posterosuperior fracture, Posterior wall

   DOI: 10.5005/jojs-10079-1138  |  Open Access |  How to cite  | 

Abstract

Introduction: Posterior wall acetabular fractures remain a common entity with respect to fractures involving the acetabulum (35–47%) of which 3.76% of them involve the acetabular roof. Our study aims to identify the mechanism of injury of these injuries involving the roof of the acetabulum and the challenges in their management. Materials and methods: This is a prospective study between January 2018 and December 2022. All surgically treated adult patients with acetabular fractures involving the posterosuperior wall or the posterosuperior wall with a posterior column were included in the study. We excluded patients with posterior, posteroinferior acetabular fractures, anterior wall fractures, column fractures, and patients medically unfit for surgery. We used a horizontal reference line connecting the superior edge of the bilateral acetabulum to evaluate the adequacy of the buttressing effect by the plate. Weller classification was used in our study. Results: A total of 20 patients (M:F = 16:4) of mean age 36.4 (±12.6) years were enrolled for analysis. According to Waller's classification, seven patients were type I, 13 patients were type II fractures, and no type III fractures. The femoral head was found to be dislocated in 10 patients and subluxation in four patients. A total of 15 patients were stabilized using lag screws and neutralization reconstruction plate and the remaining five patients were fixed with reconstruction plate in buttress mode. The average reconstruction plate length used in our study was nine holes with a mean of four holes with two screws on an average placed in the reconstruction plate superior to the reference line. Conclusion: Posterosuperior acetabular fractures are more commonly seen than any other types of posterior wall fractures with the hip in low flexion during the impact. In treating such injuries, it is essential to preoperatively analyze the superior fracture extension. For adequate visualization and reduction of these fractures, the incision is placed a little super-anteriorly, and the hip is maintained in flexion and abduction during fracture reduction.

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CASE REPORT

S Jaikish, Balaji Sambandam

A Case of Xanthoma of Bilateral Tendoachilles Reconstructed with Fascia Lata Graft X

[Year:2024] [Month:January-June] [Volume:6] [Number:1] [Pages:3] [Pages No:79 - 81]

Keywords: Case report, Cerebrotendinous xanthomatosis, Fascia lata, Tendoachilles, Xanthoma

   DOI: 10.5005/jojs-10079-1124  |  Open Access |  How to cite  | 

Abstract

Aims and background: Cerebrotendinous xanthoma is an autosomal recessive disorder characterized by a lack of production of primary bile acids and accumulation of cholestanol in various tissues like the brain, spinal cord, peripheral nerves, eyes, and tendon in the form of xanthomas. This is a case report of one such patient who had xanthoma of both tendoachilles. Case description: A 30-year-old female patient had swelling in both legs. Gradually, it became painful while walking. On examination, she had a swelling of size 10 by 4 cm attached to tendoachilles. Magnetic resonance imaging (MRI) showed features of xanthoma. Staged surgery was done. The mass was fleshy and pale yellow and replaced the entire tendon. The entire mass was removed, creating a defect of about 20 cm. Fascia lata of size 20 by 6 cm was harvested and made into a fourstrand graft. Proximally, it was sutured with fiber wires to the distal part of the muscle. Distally, it was fixed to the calcaneum using a 5 mm suture anchor. Flexor hallucis longus (FHL) tendon was used to augment the reconstruction. At 1 year, she was asymptomatic and gained good strength and ROM in the ankle. Conclusion and clinical significance: Cerebrotendinous xanthoma causes impairment in joint mobility and ambulation. Deposition of cholestanol in the neurons causes atrophy and secondary demyelination. Simple excision of tendoachilles xanthoma will do more harm to the patient who is more prone to neurological and mobility-related issues. Fascia lata graft has the advantage of limited donor site morbidity and adequate length.

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CASE REPORT

Vagta Ram, Kunal Kumar, Krishnan Rajeshwari, Deepak Kumar

Caffey Disease: Genetically Proven Case Report of 2-month-old Indian Infant

[Year:2024] [Month:January-June] [Volume:6] [Number:1] [Pages:2] [Pages No:82 - 83]

Keywords: Caffey disease, Case report, Children, COL1A1 mutation, Congenital, India, Infantile cortical hyperostosis, Musculoskeletal abnormalities, Pediatric

   DOI: 10.5005/jojs-10079-1136  |  Open Access |  How to cite  | 

Abstract

Caffey disease, or infantile cortical hyperostosis, is a rare genetic disorder characterized by abnormal bone formation and swelling of limbs in infants. This case report provides a detailed description of a 2-month-old male infant presenting with deformities of the hands and feet, along with swelling and restricted movement of the limbs. Genetic testing confirmed a mutation in the COLA1A gene, confirming the diagnosis of Caffey disease. The report discusses the clinical presentation, diagnostic evaluation, management, and follow-up of the patient, emphasizing the need for regular monitoring and further research to improve understanding and treatment options for this rare condition.

51

CASE REPORT

S Vijaya Anand, Krishnakumar Ramachandran, HD Bharath, Ranjima Abraham

Ancient Schwannoma Presenting as Sciatica Mimicker: A Case Report

[Year:2024] [Month:January-June] [Volume:6] [Number:1] [Pages:3] [Pages No:84 - 86]

Keywords: Ancient schwannoma, Case report, IDEM, Sciatica mimicker

   DOI: 10.5005/jojs-10079-1128  |  Open Access |  How to cite  | 

Abstract

Sciatica is the pain that radiates from the lower back or buttock to the posterior thigh, calf, and towards the foot. The most common cause of sciatica is intervertebral disc prolapse or degenerative spinal conditions. A few rare conditions also cause sciatica-like symptoms, termed sciatica mimicker. A case report of a 26-year-old male with back pain and radiating pain to both lower limbs. On examination, he had a positive straight leg raising test (SLR). On Magnetic resonance imaging, he had an intradural extramedullary tumor (IDEM) at the L1 level. He underwent posterior decompression and surgical resection of the tumor. Histopathological examination (HPE) consistent with Schwannoma. Lumbar schwannoma is a benign slow-growing intradural extramedullary tumor presented as a sciatica mimicker. After surgery, the patient becomes symptomatically better.

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