Asian Journal of Orthopaedic Research

A Sacrococcygeal Teratoma: Third Lower Extremity

Akcali Ayhan — 2023-07-17

Teratomas develop most frequently in the sacrococcygeum and are often diagnosed by simple observation. Most sacrococcygeal teratomas are benign, and evident in the newborn. Surgery is the primary, usually curative treatment. In this report, an unusual form of sacrococcygeal teratoma which had morphology of lower extremity is presented.

Extraspinal Sacrococcygeal Ependymoma

Akcali Ayhan — 2023-07-21

Ependymomas usually arise within the spinal cord or in the brain. Ependymomas generally originated in the sacrum or extraspinal parasacral soft tissues and they are rare tumors. We reported a case report in the subcutaneous tissue posterior to the sacrococcygeal region. Radiologic and pathologic studies are presented. Differantial diagnosis and the pathogenesis of extraspinal ependymomas are discussed.

Assessment of the Functional and Clinical Outcomes of Arthroscopic Release of Extensor Carpi Radialis Brevis in Management of Chronic Lateral Epicondylitis

K. Hal — 2023-06-28

Background: Lateral epicondylitis commonly known as tennis elbow, is one of the commonest causes of elbow pain and dysfunction. It is due to excessive use of the muscles of the back of the forearm. Histological findings include granulation tissue and micro-rupture, degenerative changes with no traditional inflammation. Nowadays, management of tennis elbow is achieved through arthroscopy for release of extensor carpi radialis brevis (ECRB) tendon.

Aim: To improve the quality of life of chronic lateral epicondylitis patients.

Subjects and Methods: This study was Quasi experimental study where Twenty-five patients with chronic lateral epicondylitis were enrolled in the study and were subjected to history taking, physical examination, and then they underwent arthroscopic release of (ECRB) tendon for management of chronic lateral epicondylitis. Outcomes were assessed by Nirschl tennis elbow score and DASH scoring system.

Results: A total of 25 patients with mean age of 43.5± 6.6 years and 44% were males. Sixty-eight percent of them had no comorbidities. Ninety-six percent of the participants had history of previous steroid injections with the mean of 1.8± 0.8. There was statistically decrease in DASH score among patients after 6 and 12 weeks of operation than preoperative (p <0.001). Also, there was statistically significant improvement in the NIRSCHL score among patients after 6 and 12 weeks compared to preoperative score (P <0.001). Postoperative complications were reported among only 2 patients.

Conclusion: We suggested that arthroscopic release of extensor carpi radialis brevis is effective in management of chronic lateral epicondylitis as it is improving function and decreasing impairment. So, we consider extensor carpi radialis brevis tendon release is a good option for treatment of lateral epicondylitis with minimal complications.

Acromioclavicular Joint Dislocation Repair Using Double Endobutton Technique: Analysis of Functional Outcome

Sujay Gupta — 2023-07-29

Introduction: Many procedures have been described for the operative management of acromioclavicular (AC) joint injuries. Some of these techniques, including hardware fixation and non-anatomical reconstructions, are associated with some serious complications and high failure rates. Recently, AC joint reconstruction techniques have focused more on anatomical restoration of the coracoclavicular ligaments to achieve optimal clinical outcomes. In our study, we have used a Double Endobutton technique to separately reconstruct the trapezoid and the coronoid portions of the coracoclavicular ligament. The purpose of this study was to evaluate the preliminary clinical and radiological results of this technique in patients with acute complete dislocation of the AC joint.

Methods: This was a prospective study conducted in Government Medical College, Kota during the period between December 2020 to December 2022, a total of 20 cases of complete Acromioclavicular Joint injuries(Rockwood type III-V) treated by reconstruction of coracoclavicular ligaments using Double Endobutton , Mersilene tape and # 5 Ethibond. We had 9 cases of Rockwood type 5, 6 cases of type 4, 5 cases of type 3. We had 6 right sided cases and 14 left sided cases. All injuries opened with vertical strap incision followed by reduction of AC joint and reconstruction done with this double endobutton technique.

Results: Outcome was measured based on DASH questionnaire and Constant score at intervals of 6 weeks, 12 weeks and 24 weeks . Radiological assessment was done at intervals of 6weeks , 12 weeks and 24 weeks with x-ray shoulder Zanca view and x-ray both shoulder AP stress view. Post operative complications were noted .At the last follow-up, 18 patients had an excellent outcome as assessed by Constant score, DASH and Quick DASH scores. One patient had good outcome while one patient had fair outcome. The mean scores at the last follow-up were: Constant score was 96 (range 80 -100), DASH score was 5.3 (range 1-11).

Conclusion: In our series double Endobutton technique has good results of functional outcome and pain free shoulder movements at a mean follow-up interval of 12 months (range, 8–14 months). Excellent reduction of the AC joint was maintained. The Double Endobutton technique is a safe and effective for the treatment of complete AC joint dislocations.

Comparison of Cruciate-Sacrificing vs Posterior-Stabilized Total Knee Replacement: A Retrospective Study

Nagesh Sherikar — 2023-08-23

Introduction: Total knee replacement (TKR) is a common surgical procedure in modern orthopaedics. There are two most commonly used implants in TKR: posterior cruciate ligament (PCL)-retaining or the Cruciate Retaining (CR) knees and posterior stabilized (PS) knees in which the Posterior Cruciate Ligament is not retained, and a mechanism in the implant stabilizes the knee. In this study we try and compare the clinical outcomes of CR and PS knees by following up patients who have undergone TKR.

Materials and Methods: In this study we have retrospectively reviewed patients who have undergone CR or PS TKR at a single tertiary care center in southern India. Patients were called at one year post surgery for the assessment, and were assessed primarily using the Knee Society Score (KSS).

Results: A total of 200 patients were included in the study. There were 100 patients in the CR group and 100 patients in the PS group. The mean KSS at 1 year was 90 in the CR group and 85 in the PS group.

Conclusion: This study found that there was no significant difference in clinical outcomes between CR and PS knees at 2 years of follow-up. These findings suggest that either type of knee replacement can be a safe and effective option for patients who are considering TKR.

Limitations: This study was limited by its retrospective design. Additionally, the study was conducted at a single academic medical center, and the results may not be generalizable to all patients who undergo TKR.

Percutaneous Osteosynthesis of Thoraco Lumbar Fractures: Is Post CT-Scann Mandatory?

Montassar Wadia — 2023-08-24

Introduction: Percutaneous fixation of traumatic thoraco-lumbar spine fractures represents an innovative technique.

The objective of our work was to evaluate the pedicle screw placement of this technique using a post-operative CT-scan.

Methods: We conducted a retrospective and descriptive study including 30 cases over a period of 2.5 years. We evaluated postoperative CT-scan parameters by studying the accuracy of pedicle screw placement using the Rao classification.

Results: The mean age was 44 years, the sex ratio was 1.3 with 17 male and 13 female. The lesion was located at the thoraco-lumbar hinge in 73.34% and in 70% it was classified as A3 with a mean posterior wall recession of 36.33%. A total of 186 pedicle screws were inserted. According to the classification of Rao 38.7% of the screws were misplaced, of which 11.29% were non-minor perforations (grade 2 and 3).

Conclusion: Postoperative CT to check the precise placement of the pedicle screws in asymptomatic patients has not shown any benefit: 11.29 % were major misplaced without any clinical repercussion. Therefore, a postoperative CT scan must be critically discussed and should be reserved for symptomatic patients.

Relevance of the Clinical and Laboratory Profile in Decision-making for Patients with Septic Arthritis

Abdulelah Alfuraym Alanazi — 2023-08-26

Background: 10%–30% of patients with adult-onset septic arthritis septic arthritis had sterile synovial fluid (SF), and it was difficult to diagnose these individuals, making care difficult. The goal of this study was to analyse the variations between persons with proven and suspected septic arthritis.

Methods: A cross-sectional descriptive study was conducted in a tertiary referral facility at King Saud Medical City, Riyadh, Saudi Arabia, from January 2022 to February 2023. After receiving clearance from the institutional ethics board, a practical sample approach was employed. The patients were recruited in the experiment after providing written informed consent. Patients over the age of 18 who had been scheduled for an arthrotomy and joint lavage by the treating surgeon and had clinical symptoms that suggested SA were included in the study. Based on the results of the analysis of the SF and tissue taken during the arthrotomy, the patients were divided into two groups: group 1 (Newman A/confirmed), and group 2 (Newman B and C/suspected).

Results: 40 patients was involved, with 21 patients placed in group 1 and 17 in group 2. The median age of the study population was 49 (36-59), and men dominated both categories (85% and 73%, respectively). Pain was the most common immediate symptom (100%) and was followed by edoema around the injured joint. Except for hip and shoulder swelling, only 25 out of the 28 people who experienced swelling. At the time of admission, a fever was found in 23.8% of patients. Seven patients were on immune-modulative drugs at the time of presentation for a number of ailments, including polymyositis, immune thrombocytopenic purpura, and post-renal transplant.

Conclusion: In order to avoid life-threatening consequences, septic arthritis is an orthopedic emergency that requires immediate and urgent treatment. Similar demographics, clinical characteristics, and laboratory data are present in both confirmed and suspected cases of septic arthritis at presentation, which might lead the treating surgeon. In the case that bacteria cannot be cultured, treatment should be based on solid clinical judgment.

Functional Outcome of Clavicular Shaft Fractures Fixation by Clavicular Locking Plate in Adults

Nripen Kumar Kundu — 2023-09-12

Background and Aim: The clavicular fracture is one of the most frequent bone fractures in people. It is typically treated non-surgically. The goal of the current study was to assess the features of surgical treatment of recently displaced clavicular fractures using compression locking plates and screws.

Methods: This prospective study was conducted at the Department of Orthopedic Surgery, Popular Medical College and Hospital, Dhaka during November 2020 to June 2022. The study included a total of 20 patients with midline fractures of the clavicle; 14 of them were men and 06 were women, with an average age of 33.35 years. Then, plate fixation was used to treat every case. Following surgery, patients were followed up at 1.5, 3, and 6 months. Clinical and radiological evaluations were performed during the observation period.

Results: Of the 20 clavicle fracture patients, who had plate fixation, 15 patients (75%) showed excellent outcomes whereas 5 patients (25%) had good functional outcomes. The typical radiological union took 10.21 weeks to complete.

Conclusion: In terms of pain alleviation, daily activities, and range of motion, plate fixation of clavicle fractures produces better functional results.

Assessment of Functional Outcome from the Hybrid Illizarov Technique in Patients with Complicated Tibial Plateau Fractures

A. H. M. Abdul Wahid — 2023-09-15

Background: Complex tibial plateau fractures pose challenges in orthopedic trauma care due to their intricate nature, potential for functional impairment, and involvement of articular disruption, metaphyseal comminution, and soft tissue injuries. Restoring joint alignment and ligament stability is crucial for favorable outcomes. Surgical methods like the Illizarov technique and its adaptations have gained attention. Existing literature reports around 50% satisfactory results regardless of closed or operative approaches. Failures result in pain, limited motion, deformities, and knee instability. Ilizarov's circular fixator is valuable for high-energy fractures with compromised soft tissues, offering stability and indirect reduction.

Aim of the Study: This study evaluates the hybrid Illizarov technique's outcomes in restoring structure and function for complex tibial plateau fractures.

Methods: This was a retrospective study. The study was conducted at the department of Orthopedics in North Bengal Medical College and Hospital, Sirajgonj, Bangladesh. One hundred and fifty-two patients were prospectively recruited with knee osteoarthritis over one year of the study period from January 2020 to December 2022.

Results: The study used the hybrid Ilizarov technique to investigate 27 patients who underwent surgical treatment for complex tibial plateau fractures. Most patients (74.07%) were aged 20-40, with the rest (25.93%) aged 41-60. Males made up 81.48% of participants, while females were 18.52%. BMI distribution showed that 44.44% had normal BMI, 29.63% were overweight, and 11.11% were obese. More injuries occurred on the right side (59.26%). Complications affected 44.44% of patients, including pin tract infections (22.22%) and joint stiffness (7.41%). Clinical outcomes varied, with around 60% achieving good outcomes, 25.93% excellent, 7.41% fair, and a similar number of poor.

Conclusion: The Hybrid Illizarov Technique demonstrates promise in addressing complicated tibial plateau fractures, showcasing favorable functional outcomes. This approach can potentially enhance patient recovery and warrants further exploration in orthopedic practice.

Distally Based Sural Fasciocutaneous Flap in the Management of Foot, Ankle, and Lower Third of the Leg Soft Tissue Defects: A Retrospective Study in the National Burn Center and Plastic Surgery of Morocco

Amine El Harti — 2023-09-20

Reconstruction of soft tissue defects in the lower extremities, especially in the regions of the foot, ankle, and lower third of the leg, presents significant challenges due to the complex vascular anatomy and limited tissue availability. The racket flap distally based sural fasciocutaneous flap has emerged as a valuable option for addressing these challenging defects. This retrospective study, conducted at the National Burn Center and Department of Plastic Surgery in Casablanca, Morocco, reports on the outcomes of 9 cases where this technique was utilized. We aim to share our experiences and assess the reliability and effectiveness of the distally based sural fasciocutaneous flap in the management of lower limb soft tissue defects.