Asian Journal of Orthopaedic Research

Caries of Elbow: An Infrequent Location with Diagnostic Quandary: A Case Report

Tarun Kumar — 2020-06-08

Tuberculous disease of elbow is a very rare entity and constitutes approximately 2-5% of all cases of skeletal tuberculosis and accounts for 10% of all extra-pulmonary tuberculosis. The disease starts from lower end humerus, olecrenon region or from upper end of radius. We report a case of extra pulmonary Tuberculosis involving left elbow joint. Early diagnosis and intervention is very necessary to prevent serious joint and bone destruction. Although biopsy is required to make definitive diagnosis, it is imperative that Orthopedician understand the typical clinical presentation and radiological imaging. Reviews of literature with emphasis on clinical manifestations, laboratory findings and imaging features are studied.

Topical Phenytoin Dressing: A Panacea in Wound Dehiscence Management Due to Implant Exposure after Orthopaedic Surgery: A Case Report

Tarun Kumar — 2020-07-09

Non-healing and wound dehiscence are major healthcare problems in today’s orthopaedic surgery. The healing process consists of various sequential events including inflammatory response, regeneration of the epidermis, shrinkage of the wound, finally connective tissue formation and remodeling. Appropriate treatment and wound care promote the healing process, prevent infection and chronicity of the wound. Different methods and approaches have been used to achieve shorter wound healing times. Inspite of various efforts the outcomes of exixting methods are sub optimal. One of the agent that has been tried in wound healing in Orthopaedics is phenytoin. The phenytoin was introduced for the effective control of convulsive disorders in 1937. An adverse effect of phenytoin is the development gum hyperplasia. This adverse effect of phenytoin of causing apparent connective tissue hyperplasia suggested an exciting possibility for its use in wound healing due to implant exposure after orthopedic surgery. We report a case of panacea effect of topical phenytoin dressing in case of wound dehiscence and exposed implant after orthopaedic surgery.

Chondromyxoid Fibroma of the Hand: A Case Report

Mohamed Othmen Chouchene — 2020-05-27

Chondromyxoid fibroma is a rare benign bone tumor whose usual location is the metaphysis of the long bones of the lower limbs, affects young adults, the location in the hand is exceptional. It is a tumor which poses a problem of differential diagnosis with chondroma and chondrosarcoma, recurrences are not uncommon and malignant degeneration remains the oretical. We present the case of a chondromyxoid fibroma of the first phalanx of the right index finger having developed wellafter excision and spongy stuffing. The objective of this work is to see the different diagnostic, therapeutic and progressive aspects of this rare pathology.

Reliability of Different Methods for Measuring Stress Radiographs in Posterior Cruciate Ligament Insufficiency

Sukrom Cheecharern — 2020-05-29

Aims: This study aims to assess the intraobserver and interobserver reliability of various measurement methods of stress radiographs in PCL insufficiency.

Study Design: Descriptive study.

Place and Duration of Study: Department of Orthopaedics, at Rajavithi Hospital, Bangkok between December 2015 and June 2016.

Methodology: Three measurement methods including Mid-Mid Method, Blumensaat's Line-Posterior Tibia Method and Blumensaat's Line-Anterior Tibia Method were employed. Each technique performed twice by two orthopaedic surgeons. Patients were assessed at day 0 and at 4 weeks. Intrarater and interrater reliability of measurements in PCL Radiographs were observed.

Results: The findings indicate that the Blumensaat's line-posterior tibia method showed the highest intraobserver reliability. For intrarater agreement, each method produced high correlation (r > 0.9) at both week 0 and 4. Regarding interrater agreement between two surgeons, high correlation (r > 0.8) was found in Mid-Mid Method and Blumensaat's Line-Posterior Tibia Method, while the Blumensaat's Line-Anterior Tibia method gave medium level of correlation (r=0.528-0.675). Both surgeons indicated similar results for each pair of measurement. The Mid-Mid Method and Blumensaat's Line-Posterior Tibia Method showed positive correlation of measurement. Mid-Mid Method and Blumensaat's Line-Anterior Tibia Method, and Blumensaat's Line-Posterior Tibia Method and Blumensaat's Line-Anterior Tibia Method showed negative correlation of measurement.

Conclusion: The Blumensaat's line-anterior tibia method produced the highest intraobserver and interobserver reliability in measuring stress radiographs in posterior cruciate ligament insufficiency.

Functional and Radiological Outcome in Displaced Supracondylar Humerus Fracture in Children Treated with Closed Reduction and Lateral or Cross Pinning- A Retrospective Study

Vishal Ashokraj Pushkarna — 2020-07-06

Background: Supracondylar Humerus Fracture (SCHF) is frequently encountered in pediatric age group and nearly three fourth of all upper extremity fractures. Most commonly used technique for surgical treatment in the displaced SCHF in children is closed reduction and stabilization with percutaneous pins.

Aim: This retrospective study was conducted to find out the outcome and safety of percutaneous pinning techniques which includes lateral pinning and cross pinning in terms of functional and radiological outcome and to see the associated complications with this method of fixation.

Materials and Methods: This retrospective study comprising of 26 cases of displaced supracondylar fracture, treated with lateral or cross pinning was carried out at Orthopedics Department, Gujarat Adani Institute of Medical Sciences and G.K General Hospital, Bhuj from May 2019 to April 2020. The inclusion criteria were: a) Gartland extension type II, III, b) age below 12 years, c) presented to OPD/Emergency within 72 hours of injury, d) closed and gustilo grade I open fractures, Patients with: a) Extension Type I of fractures, b) flexion type injuries, c) except Gustilo grade 1 open fracture d) age more than 12 year e) pervious history of fractures or nerve injury around the elbow, were excluded from the study. Postoperative immobilization was with an above elbow back splint and an arm sling. Flynn’s score was used to measure outcome.

Results: Out of the 26 patients, 18 were male and 8 were female. The children were aged 2 years to 12 years with a median age of 8.07 years. Out of all cases, 3 cases were treated by two lateral k-wires while 19 were treated by 3 lateral k-wires while only four cases were treated with cross pinning. According Flynn’s criteria; satisfactory functional results in our study were 54% of cases had excellent results, 38% had good results and 8% had a fair result. 42% of cases had excellent cosmetic results were 54% of cases had good results and 4% had a fair result.

Conclusion: In our study, we found that anatomical reduction and intra- operative stability will dictate the type of configuration to be used in SCHF.