Journal of Orthopedics and Joint Surgery

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Volume 4, Number 2, July-December 2022

EDITORIAL

Prof S Vetrivel Chezian

Post-COVID Challenges in Orthopedics

[Year:2022] [Month:July-December] [Volume:4] [Number:2] [Pages:1] [Pages No:00 - 00]

   DOI: 10.5005/jojs-4-2-v  |  Open Access |  How to cite  | 

Original Article

Kevin Ki-Wai Ho, Anthony Wai-Leung Kwok, Wai-Wang Chau, Leung-Kim Hung

Treating Frozen Shoulder with Integrative Medicine Approach by the Energy Accumulator

[Year:2022] [Month:July-December] [Volume:4] [Number:2] [Pages:6] [Pages No:49 - 54]

Keywords: Energy accumulator, Frozen shoulder, Integrative medicine, OSS, SPADI, VAS

   DOI: 10.5005/jp-journals-10079-1085  |  Open Access |  How to cite  | 

Abstract

Background: Frozen shoulder is a painful and disabling disorder of unclear cause, affecting middle-aged people after their 5th decade. They suffer from annoying pain and limited shoulder mobility. energy accumulator provides a better way of relief through an integrative medicine concept. Objectives: This study aims to evaluate the effectiveness of localized heat therapy using the energy accumulator on acupoints combined with mobilization exercise for the treatment of frozen shoulder. Methods: Thirty-eight subjects (26 females, 12 males) of age 45–65 (mean age 55.43) were recruited. An orthopedic surgeon diagnosed frozen shoulder using Codman's 12 criteria. An eight-session Traditional Chinese medicine (TCM) treatment applying heat and stroking massage was offered. All subjects completed the questionnaire set including Oxford Shoulder Score (OSS), Shoulder Pain & Disability Index (SPADI), and visual analog scale (VAS) for pain. Range of motion (ROM), muscle power, muscle circumference, and grip strength were measured. Results: Comparing with the controls from literature, the treatment group showed improvement in the OSS (mean change = 4.93, p < 0.01), SPADI (mean change = −18.9, p < 0.01), SF-12 physical (mean change = 2.5, p < 0.01), SF-12 mental (mean change = 2.6, p = 0.03), VAS (mean change = −0.5, p < 0.01), active ROM (mean change = 21.6, p < 0.01), and passive ROM (mean change = 23.7, p = 0.01). Conclusion: The results demonstrated an efficient and effective treatment effect of using the energy accumulator in treating frozen shoulders among middle-aged patients. This study was a good example of integrating Western medicine with the TCM for efficient and effective treatment outcomes.

Original Article

Komal P Gola, K G Santhosh, K Surendher

Ankle Fracture Osteosynthesis Evaluation of Functional and Radiological Outcome by Baird and Jackson Scoring System

[Year:2022] [Month:July-December] [Volume:4] [Number:2] [Pages:6] [Pages No:55 - 60]

Keywords: Ankle fracture, Baird and Jackson, Osteosynthesis

   DOI: 10.5005/jp-journals-10079-1097  |  Open Access |  How to cite  | 

Abstract

Introduction: Ankle fractures account for 10% of all fractures and are the most common lower limb injuries encountered by orthopedicians, with an incidence of 137/lakh/year. Improperly treated fractures result in long-term pain, instability, secondary arthritis, psychological, and social consequences. Therefore, a proper understanding of anatomy, mechanism of injury, radiographic interpretation forms the basis of a good outcome. Fractures treated with open reduction and internal fixation (ORIF) using the AO principles will have a good functional and radiological outcome. This study aimed to evaluate the ankle fractures treated with ORIF by Baird and Jackson scoring system. Material and methods: In this prospective study, 30 patients were classified according to Lauge-Hansen classification and underwent ORIF following AO principles from January 2019 to May 2020. Each patient was followed up for 6 months and an assessment of the outcome was done. Results: Out of 30 patients treated, overall excellent to good outcomes were obtained in 18 patients. The results were fair in six and poor in six patients. No statistical significance was noted between age, sex, mode of injury, and different method of fixation with regard to functional outcome. ORIF 48 hours after injury led to clinically significant outcomes. Overall, the meantime of the fracture union was 11.13 weeks. Statistical significance was seen in functional outcomes with regard to fracture union with a p-value of 0.001. Three patients developed complications in our study, surgical site infection in two patients and hardware irritation in one patient. Conclusion: Anatomical reduction and stable fixation are essential to maintain articular congruity in weight-bearing joints like the ankle. Short-term delay in surgery gave a favorable outcome in our series. Earlier the fracture union better the functional outcome.

Original Article

Vetrivel Chezian Sengodan, Jenny J Pynadath

Efficacy of Single Intra-articular Injection of Hyaluronic Acid for Osteoarthritis of the Knee Joint in South Indian Population

[Year:2022] [Month:July-December] [Volume:4] [Number:2] [Pages:5] [Pages No:61 - 65]

Keywords: Hyaluronic acid, Inflammation, Joint pain, Mobility, Osteoarthritis

   DOI: 10.5005/jp-journals-10079-1094  |  Open Access |  How to cite  | 

Abstract

Background: Intra-articular viscosupplements are one of the effective and safe approaches for clinical management of osteoarthritis (OA). Hyaluronic acid is one such viscosupplement which results in pain relief, reduces use of NSAIDS and delays joint-replacement surgeries. Methods: This study evaluated the efficacy of Hylan GF 20 which is approved for use in India since 2010, in a south Indian population under public health care system. Patients above 40 years of age with osteoarthritis of grade 2, 3, 4 based on KL classification were included. WOMAC score (Western Ontario and McMaster Osteoarthritis Index) was used to evaluate pain, stiffness and functioning of the knee joint. Results: Single intra articular administration of hyaluronic acid progressively decreased the WOMAC score as early as 2 weeks, with the score continued to decline until 6 months of follow up. Compared to the baseline, a 43 percent improvement in WOMAC score was observed at 6 months, reflecting a significant clinical efficacy of Hylan GF 20. Most drastic reduction in the WOMAC score observed in the grade 2 OA subgroup followed by grade 3 and 4 OA subgroups. Conclusion: The results of this study supports the use of Hylan GF 20 for the treatment osteoarthritis of knee as a single injection which can be easily adopted to public health service measures as a day care procedure.

Original Article

Snobar Gul, Younis Kamal, John Mohd, Imran Jan

Radiograph-based Morphometric Classification of Lumbar Spinal Canal

[Year:2022] [Month:July-December] [Volume:4] [Number:2] [Pages:4] [Pages No:66 - 69]

Keywords: Lumbar spinal canal, Morphology, Radiographic

   DOI: 10.5005/jp-journals-10079-1098  |  Open Access |  How to cite  | 

Abstract

Lumbar canal volume is measured by the pedicle length and interpedicular distance on plain radiographs of the lumbar spine. Since the L4 level of the lumbar spine is the central level of the lumbar canal. This level is the most commonly affected level of the lumbar spine in various pathologies like a prolapsed intervertebral disk (PIVD), lumbar canal stenosis, including discogenic or degenerative spinal disorders. During our observations, we found various patterns of lumbar spine morphology based on pedicle length and interpedicular distance of the L4 vertebra on anteroposterior and lateral lumbar spine radiographs. This new approach to divide the lumbar spine morphology into these classes will help us in predicting the susceptibility of an individual to various types of LBP and neurological complications. This will also help the operating surgeon in planning the various surgical interventions for various lumbar pathologies based on the morphology of the lumbar spine.

Original Article

Vetrivel Chezian Sengodan, Marimuthu Sivagnanam, Surendhar Rathinasamy, Ranjithkumar Selvaraj

Musculoskeletal Symptoms during COVID-19 Pandemic in a Tertiary Care Hospital in South India

[Year:2022] [Month:July-December] [Volume:4] [Number:2] [Pages:4] [Pages No:70 - 73]

Keywords: COVID-19, Knee pain, Musculoskeletal symptoms, Myalgia

   DOI: 10.5005/jp-journals-10079-1099  |  Open Access |  How to cite  | 

Abstract

Background: The symptoms of COVID-19 include fever, myalgia, arthralgia, fatigue, headache, sore throat, dry cough, anosmia, ageusia/dysgeusia, and progression to viral pneumonia. Musculoskeletal symptoms such as fatigue, myalgia, and arthralgia are common COVID-19 symptoms, but their prevalence has not yet been systematically investigated. Hence, our study aims to know the incidence of musculoskeletal symptoms in COVID-19 infection and their relationship between comorbidities like diabetes and hypertension. Methods: In our study, 1053 COVID-19 infected patients confirmed by the RT-PCR method were included. For all the patients in our study, detailed history of musculoskeletal symptoms and comorbidities were collected. Basic investigations were done for all the patients and appropriate treatment was given. The patients were followed up for persistence of musculoskeletal symptoms after discharge from the hospital. Results: During COVID-19 infection, knee joint pain was present among 251 patients (23.8%), generalized myalgia in 147 patients (14%) and 40 patients (3.8%) had both knee joint pain and generalized myalgia. In these patients, during the post-COVID follow-up, 198 patients had persistent knee joint pain, 100 patients had persistence of generalized myalgia and 38 patients had persistence of both knee pain and myalgia, whereas 19 patients developed knee joint pain and one patient developed generalized myalgia after COVID-19 infection. From our study, it is evident that the musculoskeletal symptoms are more during COVID-19 infection than during the pre-COVID period. Compared with pre-COVID status, generalized myalgia is more during the post-COVID follow-up period. This was analyzed with Cochran's Q test and was found to be statistically significant (p < 0.05). Conclusion: Our study showed an increased incidence of musculoskeletal symptoms during and after COVID-19 infection, the most common being generalized myalgia followed by knee joint pain. In patients with comorbidities like diabetes and hypertension, it is evident that musculoskeletal symptoms like knee joint pain and generalized myalgia are increased during COVID-19 infection.

Original Article

Vetrivel Chezian Sengodan, Pranesh K Manivel, Jenny J Pynadath

Computed Tomography-based Morphometric Analysis of Dorsal Vertebral Pedicle in South Indian Population

[Year:2022] [Month:July-December] [Volume:4] [Number:2] [Pages:7] [Pages No:74 - 80]

Keywords: Anatomy, Morphometry, Screw instrumentation, Spinal surgery, Thoracic pedicle

   DOI: 10.5005/jp-journals-10079-1101  |  Open Access |  How to cite  | 

Abstract

Background: The pedicle of the thoracic vertebrae (dorsal pedicle) is a cylindrical anatomical structure that bridges between the vertebral body and posterior elements. Hence, pedicle screw fixation allows stable-3-column fixation of the spine which is biomechanically superior to other methods of spinal fixation. The dorsal pedicle has a complex anatomy and its morphological characteristics vary between different ethnic populations. Hence, the present study was planned to assess the morphological characteristics of dorsal pedicle in our local population. Materials and methods: A retrospective analysis of 648 dorsal vertebrae of 54 patients (40 males and 14 females), who were all over 20 years of age was performed and compared with previously reported studies using established methods. Results: Dorsal pedicle morphometric parameters showed significant variations between gender and different ethnic population despite having a similar general pattern. Smaller pedicle width, axis length, and medial angulation of transverse pedicle angle were unique to the South Indian population in this study cohort. Females had smaller pedicle sizes when compared to males in this study. Conclusion: The morphological differences suggest caution needs to be taken for transpedicular fixation in the Indian population with Western surgical instruments, especially in the mid-thoracic region and particularly in South Indian females who have significantly smaller and shorter pedicles.

CASE REPORT

V Venkatasujith, Nitin Goyal, P C S Vishnu

An Unusual Presentation of Buckling Collapse Type of Kyphoscoliosis in Neurofibromatosis: A Case Report

[Year:2022] [Month:July-December] [Volume:4] [Number:2] [Pages:4] [Pages No:81 - 84]

Keywords: Buckling collapse type, Dystrophic type, Halo gravity traction, Neurofibromatosis, Thoracic myelopathy

   DOI: 10.5005/jp-journals-10079-1083  |  Open Access |  How to cite  | 

Abstract

Spinal deformities such as kyphoscoliosis are the most common skeletal abnormalities in neurofibromatosis. Dystrophic type of spine deformities mostly progress over time, leading to significant morbidity and mortality to the patient, hence early surgical intervention is indicated. Here we are presenting 22 years, male with dystrophic type thoracic kyphoscoliosis, who presented unusually with worsening of thoracic myelopathy after halo gravity traction (HGT), to help in the subsequent surgical correction. In literature, for buckling collapse type of kyphosis, HGT is advised and there are very few reports of worsening of neurology with the application of HGT. Hence this case report will add to the literature of treatment of severe dystrophic spinal deformities in neurofibromatosis. Key messages: Dystrophic type of spinal deformities in neurofibromatosis progress without further intervention and worsening of neurology with halo gravity traction can be an unexpected consequence while treating these patients.

CASE REPORT

Karthik Velayudham, Rajavarman Solayapan, Subin Sugath

Management of Rare Case of Solitary Metastasis Shaft of Humerus with Pathological Fracture with Intercalary Resection and Nail Cement Implantation: A Case Report

[Year:2022] [Month:July-December] [Volume:4] [Number:2] [Pages:3] [Pages No:85 - 87]

Keywords: Intercalary, Metastasis, Nail cement spacer, Pain relief, Solitary metastasis

   DOI: 10.5005/jp-journals-10079-1086  |  Open Access |  How to cite  | 

Abstract

Solitary humerus metastasis presenting with pathological fractures are relatively rare. Pathological fractures are invariably fixed in view of early mobilization, pain relief, part of palliative protocol, and disease activity debulking. Pain relief was better with plate osteosynthesis with bone cement compared to intramedullary nailing. Complication rates were equal with both these procedures including local and systemic complications. Complication rates are higher with nonlocking intramedullary nailing. Here we report a case of 70-year-old male presenting with pathological fracture humerus which was diagnosed later to be a metastatic lesion with adenocarnimoa lung. Evaluation and approach to this case is challenging to orthopedic surgeons without extensive knowledge in tumor and metastatic aspects. Hence this case report would be a valuable concise brief of this case presentation, approach, and step by step management with a brief literature review.

CASE REPORT

Prasad Soraganvi, Rishi Ram, Raghavendra RP Raju, Raju C Nagaraju, N Irfan, Kumar Guru, B Sriharsha

Review of a Rare Cause for Swelling of the Knee: Lipoma Arborescens

[Year:2022] [Month:July-December] [Volume:4] [Number:2] [Pages:3] [Pages No:88 - 90]

Keywords: Arthroscopy, Knee swelling, Synovectomy

   DOI: 10.5005/jp-journals-10079-1093  |  Open Access |  How to cite  | 

Abstract

Lipoma arborescens is an infrequent cause of chronic pain and swelling of the knee joint, and it is a slow-growing pseudotumoral lesion. Only very few cases are reported in the literature, it is most commonly seen in the knee joint, but involvement in other joints such as the wrist, shoulder, and elbow have also been reported. We report a case presented at our department with complaints of swelling of knee and pain for 1 year. The patient was evaluated and diagnosed with lipoma arborescence and was treated with total synovectomy. There is no recurrence at the end of 2 years of follow-up. In this case report, we describe the case involving the left knee and discuss the clinical presentation, diagnosis, histopathology, and treatment.

CASE REPORT

K Meenakshisundaram, Nagesh C Sangolgi, KG Kandaswamy, Hari Sivanandan, Athipathi Sundararaj, KP Chiranjeevi

A Case of Humeral Head Fracture-dislocation with Vascular Injury: How We Managed it

[Year:2022] [Month:July-December] [Volume:4] [Number:2] [Pages:3] [Pages No:91 - 93]

Keywords: Axillary artery injury, Humeral head fracture-dislocation, Proximal humerus fracture dislocation, Vascular injury

   DOI: 10.5005/jp-journals-10079-1100  |  Open Access |  How to cite  | 

Abstract

Axillary artery injury is uncommon, although proximal humerus fractures are prevalent. The majority of axillary artery injuries in the literature have been attributed to anterior glenohumeral dislocation; a few have been linked to single proximal humerus fractures or fracture-dislocation. The axillary artery is vulnerable to injury because of a proximal humerus fracture due to its anatomical placement. Due to the quantity of collateral circulation in the upper limbs, vascular damage may occur even though the radial pulse is perceptible. The most common vascular injury produced by a proximal humerus fracture was an intimal rupture with subsequent thrombosis because there are no palpable peripheral pulses and no ischemia, axillary artery injury often goes undiagnosed at first, putting the hand at risk of necrosis and amputation if ischemia persists, and the forearm at risk of compartment syndrome after revascularization. A comprehensive physical examination, as well as a low threshold for Doppler tests or angiography, can diagnose axillary artery injury. Although the vascular insult resolves spontaneously, it is vital to recognize the link between such fractures and vascular injuries in order to diagnose them early and avoid major complications, such as amputation. We provide a case of axillary artery injury associated with proximal humerus fractures to show the risk of axillary artery injury in the setting of proximal humerus fractures.

journal videos

Before HGT application

An Unusual Presentation of Buckling Collapse Type of Kyphoscoliosis in Neurofibromatosis: A Case Report

Size: 11 MB

Unsteady gait after halo gravity traction application

An Unusual Presentation of Buckling Collapse Type of Kyphoscoliosis in Neurofibromatosis: A Case Report

Size: 5 MB

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