Journal of Orthopedics and Joint Surgery

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Volume 4, Number 1, January-June 2022

EDITORIAL

Prof. S. Vetrivel Chezian

Research and Publication of Orthopedics in Tamil Nadu

[Year:2022] [Month:January-June] [Volume:4] [Number:1] [Pages:1] [Pages No:00 - 00]

   DOI: 10.5005/jojs-4-1-v  |  Open Access |  How to cite  | 

Original Article

Wai-Wang Chau, Bobby Kin-Wah Ng

What Kinds of Cosmetic Appearances were Improved after Scoliosis Surgery in Adolescent Idiopathic Patients? A Longitudinal Long-term Postoperative 7-year Study Using Spinal Appearance Questionnaire

[Year:2022] [Month:January-June] [Volume:4] [Number:1] [Pages:7] [Pages No:1 - 7]

Keywords: Adolescent idiopathic scoliosis, Appearance, Cosmetic, Longitudinal, Spinal appearance questionnaire, Surgery

   DOI: 10.5005/jp-journals-10079-1048  |  Open Access |  How to cite  | 

Abstract

Background and aim: The primary purpose of spinal corrective surgery is to prevent scoliosis progression by spinal fusion at the regions of involvement. Patients would like to see corrections on their trunk appearance along with the spinal correction. Long-term longitudinal follow-up of cosmetic trunk appearance in surgical adolescent idiopathic scoliosis (AIS) patients using solely an appearance-specific questionnaire has not yet been reported. Materials and methods: All severe AIS patients operated on from the year 2014 to 2016 were recruited. They completed a spinal appearance questionnaire (SAQ) at a time point from <1 year to 6–7 years after surgery (7 time points). Spinal appearance questionnaire domain scores from the 7 time points were compared using ANOVA with multiple comparison corrections. Results: There were 76 severe AIS patients recruited, of which 74.1% were females, and the mean age at operation was 15.97. Mean”General,” “Waist,” and “Chest” SAQ domain scores were consistently scored high across the 7 time points. The “surgical scars” domain consistently scored the lowest among the nine SAQ domains. Female patients observed significantly better mean “Curve” and “Trunk shift” domain scores at 4–6 years compared with <2 years despite none found in male patients. Conclusion: Postoperative AIS patients were highly satisfied with their general appearance, waist, and chest 7 years after surgery. “Surgical scars” was persistently the least satisfied domain across the 7 years after surgery. Gender difference existed of which female patients felt significantly better on their “curves” and “trunk shift” after 4 years of surgery but the significance was not found in male patients.

Original Article

Nilesh D Darawade, Praveen Bhardwaj, Raja Sabapathy Shanmuganathan

Static Traction and Early Mobilization Protocol for Intra-articular Fractures of Proximal Interphalangeal Joint: Technique and Outcome

[Year:2022] [Month:January-June] [Volume:4] [Number:1] [Pages:6] [Pages No:8 - 13]

Keywords: Fracture-dislocation, Mobilization protocol, Proximal interphalangeal joint, Static traction

   DOI: 10.5005/jp-journals-10079-1050  |  Open Access |  How to cite  | 

Abstract

Aim and background: Intra-articular fractures of the proximal interphalangeal (PIP) joint are a difficult entity to treat, commonly leading to stiff and painful fingers. There are multiple techniques described for treatment. We utilize a simple technique consisting of a static traction assembly and early mobilization of the finger to treat this pathology. In this study, we present results obtained with this modality. Materials and methods: We utilize a malleable aluminum splint for traction against the injured finger. No. 1 polypropylene suture through nail plate of injured finger applies traction to hold joint in reduced position for 2 weeks. At 2 weeks, active-assisted mobilization of the injured finger is begun. Patients were evaluated for the range of motion achieved, radiograph picture, presence of pain, and ability to return to work. Results: There were 11 cases of intra-articular fractures of the middle phalanx base. The median period of follow-up was 15 months (range 7.5–31 months). The average active flexion possible at the injured joint was 87.7°(range 55–110°). Two patients reported mild pain on terminal flexion without functional limitations. In unstable injuries, suboptimal alignment of fracture was common [9 out of 11]. Despite suboptimal radiographs, patients had a functional, painless range of motion. All patients went back to previous work. Conclusion: Static traction technique with early mobilization protocol is a safe, relatively simple, and effective technique in the management of intra-articular fractures of the PIP joint. Early mobilization of joint facilitates remodeling of the articular base of the middle phalanx with the recovery of painless motion at the PIP joint despite radiological abnormalities.

Original Article

Thirumalai Murugan, Arivasan Rathinam, Sathiya Prakash

Delayed Neurological Deficit in Osteoporotic Vertebral Compression Fracture: An Analysis of Surgical Outcome

[Year:2022] [Month:January-June] [Volume:4] [Number:1] [Pages:5] [Pages No:14 - 18]

Keywords: Delayed neurological deficit, Nonunion, Osteoporosis, Osteoporotic vertebral fractures, Vertebroplasty

   DOI: 10.5005/jp-journals-10079-1080  |  Open Access |  How to cite  | 

Abstract

Introduction: The International Osteoporosis Foundation has estimated that worldwide, approximately 30–50% of people aged over 50 years are at risk for the development of fragility fractures secondary to osteoporosis. Vertebral compression fractures occur in 20% of people older than 70 years and in 16% of postmenopausal women. The majority of fractures heal with conservative treatment after 8–10 weeks. Surgery is indicated for patients who present with neurological deficits, deformities, and incapacitating pain with conservative treatment failure. Two percent of patients with osteoporotic vertebral fractures (OVFs) develop cord compression. This study aimed to identify the clinical presentation and predictors of clinical outcomes among patients operated for delayed neurological deficits after OVFs. Materials and methods: eight cases—five women, three men, dorsolumbar junction—seven cases, dorsal spine one case. Neurological status – ASIA B – 1 – ASIA C – 5 – ASIA D – 2. All cases underwent posterior short segment fixation (pedicle screws one level above and below the fracture vertebra) and percutaneous vertebroplasty and indirect decompression. Results and analysis: Postoperatively neurology improved up to ASIA grade E – 7, grade D – 1. All patients were followed up with neurological assessment every 2 weeks up to 3 months and every month up to 6 months. One patient could not walk, and seven patients walked with assistance. Two patients had sphincter disturbance. The mean preoperative Baba\'s score was 6 and postoperative score was 11 after follow-up. The mean values of lateral anterior vertebral body height (LAH) were 41.0% preoperatively and 60.7% postoperatively, and lateral posterior vertebral body height (LPH) were 37.4% preoperatively and 58.8% after 6 months postoperatively. The average retropulsion was 36.5%. Conclusion: Although OVFs are common and generally considered benign, severe and delayed neurological deficits can occur following spinal cord compression. In experienced hands and with appropriate patient selection, posterior short segment fixation (PSF) and vertebroplasty is a safe and efficacious procedure for the treatment of osteoporotic compression fractures with neurological deficit.

Original Article

Pramod Devkota, Shiraz Ahmad

Traumatic Hip Dislocation: An Experience from a Public General Hospital of Brunei

[Year:2022] [Month:January-June] [Volume:4] [Number:1] [Pages:3] [Pages No:19 - 21]

Keywords: Anterior, Dislocation, Hip, Posterior, Trauma

   DOI: 10.5005/jp-journals-10079-1052  |  Open Access |  How to cite  | 

Abstract

Introduction: Traumatic dislocation of the hip (TDH) is an orthopedic trauma emergency, which is commonly due to high-energy trauma. Morbidity and mortality are very high usually resulting from the associated injuries sustained during the trauma. The condition of the victims worsened when associated with acetabular or femoral head fractures. The prevalence of hip dislocations is increasing worldwide. Materials and methods: From August 2011 to March 2018, a total of 27 cases of traumatic hip dislocation were treated in a public general hospital. The emergency reduction was performed, immobilization with skin tractions was done for 3 weeks by admitting to the hospital. After 3 weeks of hospital stay, discharged and advised for non-weight bearing (NWB) crutch walk for another 3 weeks. Medical records of all patients after 1 year of dislocation were reviewed. Results: There were 21 (77.78%) males, 6 (22.22%) females, and the mean age of the patient was of 37.59 ± 13.69 years (range 8–71), posterior dislocation occurred in 18 (66.66%) cases, anterior dislocation on 6 (22.22%) cases, and central dislocation on 3 (11.11%) cases. The right hip was dislocated in 17 (62.96%) cases and left in 10 (37.04%) cases. A road traffic accident (RTA) was the cause for 16 (59.25%) cases, fall injury in 8 (29.62%) cases, and physical assaults in 3 (11.11%) cases. Associated injuries like abdominal, thoracic, pelvic and acetabular fracture, upper and lower limbs injuries, and sacroiliac joint injury were found in 17 (62.96%) cases. Conclusion: Traumatic dislocation of the hip is a severe injury caused mostly by RTA and young adults are most commonly affected.

Original Article

Vijayanand Ramasamy, Rajkumar Nallan

Functional Outcome of Bipolar Hemiarthroplasty for Proximal Femoral Neck Fractures in Elderly: A Prospective Study

[Year:2022] [Month:January-June] [Volume:4] [Number:1] [Pages:4] [Pages No:22 - 25]

Keywords: Bipolar hemiarthroplasty, Elderly patients, Harris hip score, Proximal femoral neck fracture, Trochanteric fracture

   DOI: 10.5005/jp-journals-10079-1053  |  Open Access |  How to cite  | 

Abstract

Aim and background: Hip fractures are the most frequently seen injuries by orthopedic surgeons and are particularly prevailing in the geriatric community. This study was performed to evaluate the efficacy of the bipolar hemiarthroplasty among elderly patients with a proximal femoral neck fracture. Materials and methods: This was a prospective study undertaken at the Department of Orthopedic Surgery at a tertiary care institute from January 2014 to December 2015. The patients were selected based on the convenience sampling (Judgment sampling) method. Bipolar hemiarthroplasty was performed. The majority had cemented implants, with three having uncemented. Functional outcome was assessed periodically at 6 weeks, 3 months, 6 months, and 1 year using modified Harris hip scoring system using coGuide for statistical analysis and p value set at 0.05. Results: A total of 43 patients >50 years of age with 23 (54.5%) males and 20 (45.5%) females, among which 39 (90.69%) with fractured neck of femur and 4 (9.31%) with trochanteric fracture were studied. Forty (93%) had cemented implants. Harris hips ROM score 5 was noted in 50% of the participants, scores 4 and 3 in 42.5 and 7.5%, respectively. Excellent functional score was noted in 16 (40%), good in 18 (45%), satisfactory in 3 (7.5%), and 3 (7.5%) had poor score. Only two (5%) participants had radiolucent zone >2 mm and one (2.5%) had subsidence of prosthesis >5 mm. Conclusion: Cemented bipolar hemiarthroplasty is present in mobile geriatric patients above 50 years of age with a proximal femoral neck fracture. Clinical significance: A bipolar hemiarthroplasty is a reliable option in treating fracture neck of femur in the elderly with several comorbidities. All the participants had a sufficient functional outcome in regular daily activity, less hospital stay, residual pain, postoperative functionality, and fewer postoperative complications. It can be used in day-to-day clinical practice.

Original Article

Vetrivel Chezian Sengodan, Kumaravel Ramakrishnan, Saisarrvesh Purushothaman, Karthikeyan Kandasamy, Murugesh Munusamy

A Novel Idea to Reduce the Consumption of Povidone-iodine in the Operation Theater: A Need of the Hour for Developing Countries

[Year:2022] [Month:January-June] [Volume:4] [Number:1] [Pages:3] [Pages No:26 - 28]

Keywords: Antiseptics, Povidone-iodine, Surgical site infection

   DOI: 10.5005/jp-journals-10079-1054  |  Open Access |  How to cite  | 

Abstract

Introduction: Surgical site infection (SSI) is the most common hospital-related infection in developing countries. Antiseptics are used to prevent SSIs. Iodine, alcohol, and chlorhexidine are commonly used for preoperative skin preparation. Of these, povidone-iodine is most commonly used in the operation theater. Aim and objective: Our study aims to compare the quantity of povidone-iodine used in operation theater by a conventional method with the measurable spraying device method. Materials and methods: This prospective study was conducted in Government Coimbatore Medical College Hospital at Institute of Orthopedics and Traumatology, Coimbatore, Tamil Nadu from 2018 to 2019 in its four elective theaters and one 24 × 7 emergency operation theater. We sprayed povidone-iodine over the skin during the preoperative skin preparation and calculated the usage for every patient with measurement in the bottle and compared it with the conventional method of skin preparation with the gauze soaked in povidone-iodine solution in a sterile bowl. Results: The average amount of povidone-iodine solution used per case for the years 2018 and 2019 were 120.08 and 35.83 mL, respectively, thereby reducing 70% of the usage of povidone-iodine consumption. Conclusion: By using a transparent spraying bottle with measurement on the container, the quantity of povidone-iodine utilization in the operating room can be drastically reduced, thereby reducing the cost spent for antiseptics in health care.

Original Article

Singaravadivelu Vaidyanathan, Vignesh Murali, Aju Bosco

Effectiveness of Standalone Weight-bearing Radiographs in Guiding the Management of Supination External Rotation Type Isolated Lateral Malleolar Fractures in Indian Population: A Prospective Clinical Study

[Year:2022] [Month:January-June] [Volume:4] [Number:1] [Pages:6] [Pages No:29 - 34]

Keywords: Ankle, Ankle fracture, Ankle instability, Deltoid ligament, Lateral malleolus, Weight-bearing radiograph

   DOI: 10.5005/jp-journals-10079-1084  |  Open Access |  How to cite  | 

Abstract

Aim and objective: To assess the effectiveness of standalone weight-bearing radiographs (WBR) in guiding the management of Supination External Rotation (SER), type of isolated lateral malleolar fractures in Indian population. Materials and methods: In a prospective study involving 19 consecutive patients with SER type of isolated lateral malleolar fractures, stability of the ankle was assessed using both WBR and external rotation stress radiographs. The decision toward conservative or surgical management was made solely on the assessment of ankle stability on WBR alone. Fractures with a medial clear space of <5 mm were deemed stable and managed conservatively (full weight-bearing in cast), while unstable ones were managed surgically (with open reduction and fibular plating). Periodic follow-up was done to assess radiological union and functional outcomes using the American Orthopaedic Foot and Ankle Society (AOFAS) score. Patient\'s pain score visual analogue scale (VAS) and compliance was assessed during radiographic assessment. Results: Based on WBR alone, 17/19 (89.5%) fractures were found to be stable and treated conservatively, while 2/19 (10.5%) fractures were unstable and managed surgically. The mean AOFAS score in the conservative group [92.9 ± 3.4 (excellent)] and surgical group [91.5 ± 1.5 (excellent)] were comparable at latest follow-up. Complete radiological union was seen at 8.8 ± 1.9 (range, 8–14) weeks in 82% (14/17), while delayed union (union taking place >8 weeks) was seen in three patients in the conservative group. Four patients (21%), who would have been operated had external rotation stress views been used in decision making, were managed conservatively with successful clinical outcome and excellent AOFAS scores. Patient compliance was good with WBR as compared to external rotation stress radiographs. Conclusion: Standalone WBR are feasible, and reliable in detecting injury of the deep deltoid ligament and the consequent instability of the tibiotalar joint, in Weber type B fractures. They are associated with better patient compliance. Clinical significance: Standalone WBR serve as a useful guide in decision making between conservative and surgical treatment, in SER type isolated lateral malleolar fractures.

REVIEW ARTICLE

C Rex, M Harish Kumar, C Premanand, AS Satish Kumar

A Legendary Implant that has Stood the Test of Time and its Current Utilization

[Year:2022] [Month:January-June] [Volume:4] [Number:1] [Pages:5] [Pages No:35 - 39]

Keywords: Closed/open reduction, Forefoot injuries, Kirschner wire, K-wire Fusion, Orthopedic K-wire, Trauma, Trauma surgery

   DOI: 10.5005/jp-journals-10079-1081  |  Open Access |  How to cite  | 

Abstract

Aim and objective: To elaborate the current stand on K-wire usage in orthopedic clinical practice. Background: K-wire is a commonly used implant, and is an inevitable instrument in orthopedic practice. Even with the rampant usage of this implant for centuries, the literature stating the basic details, principles of use, current clinical indications, complications encountered and techniques to avoid the same is not many. In this review article, we have taken into consideration the essential details, techniques, various clinical scenarios and extended indications for which a K-wire can be used. We believe that this article will comprehensively enlighten all the perspectives of K-wire usage, yet unmentioned and highlighted so far in any available literature. Review results: K-wire has been introduced into orthopedic practice more than 100 years ago. This is the oldest implant that has stood the test of time in the management of many fractures of both upper and lower limbs. The indications for which the K-wire was invented has changed completely and current indications are totally diverse. With recent developments of newer technologies to stabilize fractures or reconstructive procedures with the newer implants, K-wire still has an important role in the management of fractures. This flexible implant has an immense role in minimally invasive surgical management. Conclusion: A gap exists in the literature on the techniques and procedures employed using K-wires, which warrants more research. This article serves to enlighten the current rationale of the use of K-wires in orthopedic practice and its future perspectives. Clinical significance: Considering the cost of healthcare, this implant satisfies cost-effective management with good functional outcomes in fixation of a certain peripheral skeleton and pediatric fractures with the least complication rate. K-wire has many advantages like ease of application, minimally invasive, easy availability on the shelves of operating rooms, in any nook and corner of the world, and the versatility of its use in difficult scenarios.

CASE REPORT

Pak-Cheong Ho, Josephine M-W Wong, Wai-Wang Chau, Alice H-Y Cheung, Hiu-Wun Wong, Gabby S-S Hui, Edwin Lee, Judia S-C Yue, Michael Mak, Wing-Lim Tse

Budding Well: A Fun and Sharing-based Rehabilitation Program through Music and Arts for the Children and Teenagers with Extremity Anomalies

[Year:2022] [Month:January-June] [Volume:4] [Number:1] [Pages:7] [Pages No:40 - 46]

Keywords: Art, Child, Musculoskeletal abnormalities, Music, Rehabilitation

   DOI: 10.5005/jp-journals-10079-1041  |  Open Access |  How to cite  | 

Abstract

Introduction: Children with physical disabilities are less likely to access music and arts due to their extremity anomalies. “Budding Well” is a non-conventional rehabilitation program providing music and arts courses for the targeted participants. The program has run through the third year and a review of the service outcomes has been sorted. Materials and methods: Aged 6–18 years with different kinds and degrees of limb dysfunctions were invited to join the program. The course consisted of 10 learning classes on playing harmonica (music) or painting (arts). Functional assessments [Bruininks-Oseretsky-Test-of-Motor- Proficiency second edition (BOT-2) and Grip-and-pinch strength] and psychosocial centric questionnaires [Lyubomirsky and Lepper\'s Subjective Happiness Scale (SHS), Well-being Index (WHO-5), and Culture-free Self-esteem Inventory-2 (CFESI-2) Form A] were performed and completed at the first and last (10th) class. Program evaluation questionnaire was filled at the last class. Results: Thirty-five participants (male = 20, female = 15) of mean age 8.65 joined the program. Functional assessments and psychosocial centric questionnaire outcomes except CFESI-2 did not show any statistical difference. Age sensitivity testing in CFESI-2 Social domain score showed the best result when cut-off age was at 10.5 (p = 0.04) and this cut-off value was further proved by receiver operating characteristic (ROC) analysis (p < 0.01). On subjective evaluation, parents noticed a significant improvement in the hand function of their children (p= 0.01). Conclusion: Hand functions and psychosocial skills of children and teenagers with different levels of physical disabilities or disfigurement proved to benefit from our program through music and arts. Participants of age at 10.5 best responded to the program, particularly on the significant improvement in self-esteem.

CLINICAL TECHNIQUE

Sivaraman Balasubramanian, Dinesh Loganathan, Venkataraman Manian, Rahul Vijay Gusain, Bobby Mathiyarasu

A Novel Technique in Collecting Biopsy in Arthroscopy

[Year:2022] [Month:January-June] [Volume:4] [Number:1] [Pages:2] [Pages No:47 - 48]

Keywords: Arthroscopy, Biopsy, Echnique, Shaver

   DOI: 10.5005/jp-journals-10079-1082  |  Open Access |  How to cite  | 

Abstract

Aim and objective: A novel technique in collecting biopsy in arthroscopy. Background: Various methods are described by authors to collect intra-articular biopsies, in recent times arthroscopy is considered the gold standard for the same. Our novel technique helps us to collect a sufficient amount of soft tissue which elevates the concern of inadequate soft tissue collection especially when small joints are considered. Technique: Gauze barrier technique. Conclusion: This novel technique allows us to collect a sufficient amount of intra-articular soft tissues especially when small joints are considered which results in easy collection of tissue and saves time and effort for the surgeons. Clinical significance: Minimum ports, less operative time, easy maneuverability, and comparatively easy way to collect sufficient tissue.

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