Journal of Orthopedics and Joint Surgery

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Volume 3, Number 2, July-December 2021

EDITORIAL

Prof. S. Vetrivel Chezian

Genesis of Orthopedics in Tamil Nadu

[Year:2021] [Month:July-December] [Volume:3] [Number:2] [Pages:1] [Pages No:00 - 00]

PDF  |  DOI: 10.5005/jojs-3-2-v  |  Open Access |  How to cite  | 

Original Article

Vetrivel Chezian Sengodan, Suresh Kumar Vadivelu

Clinical Outcome after Hemiarthroplasty among Patients with Fracture Neck of Femur in South Indian Population

[Year:2021] [Month:July-December] [Volume:3] [Number:2] [Pages:5] [Pages No:65 - 69]

Keywords: Elderly, Femoral neck fracture, Hemiarthroplasty

PDF  |  DOI: 10.5005/jp-journals-10079-1037  |  Open Access |  How to cite  | 

Abstract

Background: Femoral neck fractures in the elderly are serious injuries, often occurring in the terminal years of life and they have a major impact on society, our healthcare system, and the cost of care. It has a high incidence rate and complications. A successful surgery at the hip joint should provide a painless and stable hip. Hemiarthroplasty is the common method of treating displaced femoral neck fractures in Garden\'s type III and IV in the elderly. This study aims to evaluate the clinical outcome and quality of life following hemiarthroplasty. Materials and methods: It is a retrospective study including a total of 101 patients who underwent hemiarthroplasty (cemented/uncemented) using unipolar or bipolar prosthesis due to femoral neck fracture at the Institute of Orthopaedics and Traumatology, Coimbatore Medical College Hospital, Coimbatore, during the period of 2 years between 2017 and 2019. In this analytical retrospective study, we studied several variables including age, sex, socioeconomic status, medical comorbidities, clinical outcome, postoperative complications, quality of life, frequency of follow-up, and mortality. Results: In our study, most of the patients were in the age-group of 60–70 years with a mean age of 65 years. This study was carried out on 43 males and 58 females. There was no intraoperative complication/mortality. A total of 21 patients had complications. These were (a) posterior dislocation (3), (b) aseptic loosening (1), (c) periprosthetic fracture (1), (d) superficial infection (11), (e) deep infection (1), and other minor complications like persistent hip pain and muscle wasting. The mortality rate was about 23.7% at 1-year follow-up. Conclusion: The overall complications following hemiarthroplasty were acceptable. The immediate complications rate was about 8.9% and the late complication rate was about 17.8%. Targeted medical intervention that focuses upon susceptible patient groups may reduce morbidity, mortality, and improve survival.

Original Article

Vetrivel Chezian Sengodan, Arun Subramanian

Management of Compound Metatarsal Fractures under Tamil Nadu Accident and Emergency Care Initiative

[Year:2021] [Month:July-December] [Volume:3] [Number:2] [Pages:6] [Pages No:70 - 75]

Keywords: Government of Tamil Nadu chief minister\'s comprehensive health insurance scheme, Kirschner wire, Metatarsal fractures, Tamil Nadu accident and emergency care initiative

PDF  |  DOI: 10.5005/jp-journals-10079-1047  |  Open Access |  How to cite  | 

Abstract

Introduction: Metatarsal fractures are common among foot injuries. This study aimed to evaluate and analyze the functional outcomes of compound metatarsal fractures using the anterograde retrograde fixation technique under the Tamil Nadu Accident and Emergency Care Initiative. Materials and methods: This is a prospective study done on patients admitted with compound metatarsal fractures in emergency orthopedic unit, Government Coimbatore Medical Hospital under Tamil Nadu Accident and Emergency Care Initiative between January 2020 and December 2020. The displaced compound metatarsal fractures are treated with limited internal fixation using Kirschner\'s wires within the golden period of 6 hours and they were covered under Government of Tamil Nadu Chief Minister\'s Comprehensive Health Insurance Scheme–Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (TNCMCHIS-AB-PMJAY). Anterograde retrograde technique was used for the fixation of compound metatarsal fractures. Results: The American Orthopaedic Foot and Ankle Society score was used to assess the functional outcome of compound metatarsal fractures. Good results were observed in 32 patients and excellent results were observed in 5 patients. Fair results were seen in three patients. Conclusion: The compound undisplaced metatarsal fractures can be treated conservatively. The displaced metatarsal fractures need limited internal fixation with Kirschner\'s wires. The Tamil Nadu accident and emergency care initiative provide early treatment and early discharge of the patients. The health department is no more an expenditure department for the government since it generates money from TNCMCHIS–AB-PMJAY which is very useful for the patients from below poverty line.

Original Article

Prabhat Agrawal, SV Sunny Deol, N Rajkumar, V Arul Jothi, Murali Mothilal

An Interventional Study on Antibiotic Cement-coated Nails and Cement Beads in the Management of Infected Nonunion of Long Bones

[Year:2021] [Month:July-December] [Volume:3] [Number:2] [Pages:4] [Pages No:76 - 79]

Keywords: Antibiotic cement-coated nails, Cement beads, Infected long bone

PDF  |  DOI: 10.5005/jp-journals-10079-1049  |  Open Access |  How to cite  | 

Abstract

Background: The present study was aimed to assess the efficacy of antibiotic cement-coated nails and cement beads among the cases of infected nonunion of long bones. Materials and methods: This prospective interventional study was conducted among the cases admitted in the emergency and outpatient department of Orthopedics in Patna Medical College and Hospital, Patna, with infected nonunion of long bones, during the month of June 2010 to August 2012. All cases with an infected nonunion of extremities with implants were included. A total of 44 cases were included. Data analysis was done using SPSS version 17. Results: In this study, out of 44 infected nonunion, 40 were cured of infection, 3 cases had occasional discharge, and 1 case had a continuous discharge. Secondary procedures were done for the 40 cured cases and among them, 37 showed complete achievement of union, and 3 cases had occasional discharge and no case had a continuous discharge. Conclusion: The use of antibiotic cement-coated nails and cement beads among the cases with infected nonunion of long bones significantly reduced the requirement of a further surgical procedure like debridement of the wound site.

CASE REPORT

Periakaruppan Ramasamy, Masilamani Kalaivanan

Abnormal Division of Radial Nerve Encountered during Fixation of Fracture of Shaft of Humerus through Anterior Approach

[Year:2021] [Month:July-December] [Volume:3] [Number:2] [Pages:2] [Pages No:80 - 81]

Keywords: Early rehabilitation, Fracture, Functional outcome

PDF  |  DOI: 10.5005/jp-journals-10079-1034  |  Open Access |  How to cite  | 

Abstract

Variation in the branching pattern of the posterior cord of the brachial plexus is a rare occurrence when compared with the variations in the branching pattern of the medial and lateral cords. Even more rarer is the variation in the branching pattern of the radial nerve. This article is a report of the observation made during surgical fixation of humerus shaft fracture through the anterior approach wherein radial nerve was seen as anterior and posterior divisions rather than a single nerve bundle. The anterior division continued as the main radial nerve and posterior division gave branches to the triceps muscle. An orthopedic surgeon should be aware of radial nerve divisions while exposing the humerus shaft and butterfly fragment for fracture fixations. Bone clamps should be applied with caution.

CASE REPORT

Selvaraj Velusamy, Sathyanarayana Venkat Ramaiah, Amar Murugananthan

The Surprising Tale of Dark Replacement

[Year:2021] [Month:July-December] [Volume:3] [Number:2] [Pages:5] [Pages No:82 - 86]

Keywords: Alkaptonuria, Ochronosis, Patella tendon avulsion

PDF  |  DOI: 10.5005/jp-journals-10079-1036  |  Open Access |  How to cite  | 

Abstract

Alkaptonuria is caused by the defective metabolism of homogentisic acid, which causes arthritis and connective tissue pigmentation. The knee is a commonly affected joint. Total knee arthroplasty (TKA) has been suggested as an effective treatment for end-stage ochronosis arthropathy. A case of a 62-year-old man presented with pain in both knee joints and X-rays revealed advanced degenerative arthritis. During knee replacement, the subcutaneous tissues revealed blackish nodules. It was difficult to retract the patella as the patella tendon was stiff and hard with blackish discoloration. On dislocating patella, the patella tendon was avulsed on the right knee; later, it was fixed with a suture anchor and stapler. To avoid patella tendon avulsion, we did a tibial tuberosity flip osteotomy on the left knee. Ochronosis arthropathy should be considered as a diagnosis when faced with black connective tissue intraoperatively. Surgeons should anticipate patella tendon avulsion and difficulties in soft tissue balancing in the onchronitic knee and ready to tackle the complications.

CASE REPORT

SV Akshay Kumar, R Deivanayagam, SA Rajkumar, Sunder Lal Negi, J Balasubramaniam

Proximal Humerus Osteosarcoma: Limb Salvage Surgery Using Custom-made Shoulder Arthroplasty and Capsule Reconstruction with the Aortic Synthetic Graft

[Year:2021] [Month:July-December] [Volume:3] [Number:2] [Pages:4] [Pages No:87 - 90]

Keywords: Aortic synthetic graft, Osteosarcoma, Prosthesis, Reconstruction, Tumor surgery

PDF  |  DOI: 10.5005/jp-journals-10079-1042  |  Open Access |  How to cite  | 

Abstract

Case description: We are presenting our patient with osteosarcoma in the right proximal humerus from the Southern Region of India. He had been managed well with reconstructive surgery using prosthesis and shoulder capsule reconstruction with the synthetic aortic graft. This 64-year-old, pleasant gentleman presented to us with acute onset of right shoulder pain and limitation of movements of the right shoulder joint limiting his routine activities. It had been successfully managed by a team of specialists with limb-salvage surgery. Conclusion: We validate that this tumor can occur in the proximal humerus of our Indian-aged man and when he presents to us early, he can be treated well by limb salvage with reconstructive surgery.

CASE REPORT

Sivakumar Raju, Chidambaram Muthu, Sudeep Kumar Velur Nagendra Reddy, Vinoth Thangamani, Bharat Kumar Ramalingam Jeyashankaran, Arunraj Sambandam

Thoracic Fungal Osteomyelitis with Compressive Myelopathy in an Immunocompetent Individual by a Rare Fusarium Species: A Case Report

[Year:2021] [Month:July-December] [Volume:3] [Number:2] [Pages:4] [Pages No:91 - 94]

Keywords: Dorsal spine epidural abscess, Fungal osteomyelitis, Fusarium

PDF  |  DOI: 10.5005/jp-journals-10079-1051  |  Open Access |  How to cite  | 

Abstract

Background: Thoracic vertebral osteomyelitis/spondylodiscitis and spinal epidural abscess are rare but life-threatening conditions, commonly seen in immunocompromised persons. It requires early detection and prompt management, to avoid late sequelae and complications. The cause for this abscess can be pyogenic, tuberculosis, fungal, or parasitic. Candida and Aspergillus species are the most common fungal causes which mainly present as discitis or osteomyelitis in the immunocompromised patient, after hematogenous dissemination. Case discussion: We report about Fusarium, an opportunistic human pathogen which is a normal commensal of human skin flora, in a 60-year-old healthy gentleman with no immunocompromised stage, the rare cause of thoracic vertebral osteomyelitis with epidural abscess D9 to D11 with compressive myelopathy and neurological deficit in this article. Conclusion: Along with aerobic, anaerobic bacterial and tuberculous, microbiological and histopathological investigations should also include fungal workup. Proper fungal isolation from the tissue is a must for prompt treatment and a better outcome for the patient.

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