Open Access Case Report

A Case Study of Secondary Synovial Osteochondromatosis of Knee

Mohit Gera, Basant Rai, Parminderjeet Singh Bhullar, Ashish Shukla, Dixit Bansal, Vishal Preet Singh, Ashish Chauhan

Asian Journal of Orthopaedic Research, Volume 5, Issue 2, Page 195-201

Synovial osteochondromatosis (SOC) is a proliferative synovial disease. Which has a rare incidence and presents as numerous osteo-cartilaginous nodules in bursae, synovial joints and tendon sheaths. Diagnostic modalities for synovial chondromatosis include radiographs, CT scan or MRI, with definitive characteristics being determined by histological examina­tion. Therapeutic options commonly include either arthroscopic or open procedures which prevent further articular and peri‑articular damage and abolish symptoms The following case report describes a 42 year male patient presenting with a secondary synovial osteochondromatosis of knee managed successfully with open procedure for the removal of the loose bodies.

Open Access Systematic Review Article

Percutaneous Endoscopic Transforaminal Discectomy vs Conventional Open Lumbar Discectomy for Lumbar Disc Herniation: A Systematic Review

Yo Tendy Pratama, Tito Sumarwoto , H. Nicko Perdana, S. Dhanan Prastanika, Rieva Ermawan

Asian Journal of Orthopaedic Research, Volume 5, Issue 2, Page 286-297

Introduction: Despite the fact that there are various surgical procedures for lumbar disc herniation, open lumbar microdiscectomy is the most effective. Percutaneous endoscopic lumbar discectomy has recently become a popular procedure for treating herniated lumbar discs.

Objectives: The aim of this study is to determine whether percutaneous endoscopic lumbar discectomy and conventional open lumbar discectomy show better results as a surgical treatment of lumbar disc herniation. To evaluate the surgical outcomes and advantages of each technique as well as to describe the technical strategy and evaluate the outcomes of the PETD technique specific to LDH.

Methods: In this review's analysis, studies examining endoscopic percutaneous endoscopic transforaminal discectomy and conventional open discectomy—both surgical procedures for treating herniated lumbar discs—were looked at. In the Google Scholar and PubMed databases, papers published between 1973, the year percutaneous endoscopic lumbar discectomy was first introduced, and 2022 were searched.

Results: The 8 publications that had 5,314 patients were chosen. Percutaneous endoscopic lumbar discectomy has a noticeably better outcome than open lumbar microdiscectomy, according to the comparative study. All procedures have good results, as seen by the comparison between PETD operations and traditional surgical discectomy. A better visual analog pain scale (VAS), a better confidence interval, reduced blood loss, a shorter operating time, a shorter length of stay, fewer complication rates, lower recurrence rates, and a low reoperation rate are some benefits of the PETD method.

Conclusion: Although percutaneous endoscopic lumbar discectomy exhibits superior outcomes to traditional surgical discectomy in a number of areas. The traditional open discectomy still yields positive clinical outcomes. In order to compare these two surgical approaches, it is anticipated that a systematic review trial with a sizable research sample and more literature would be required in the future.

Open Access Case Study

Proximal Femoral Derotational Osteotomy in a 14-Year-old Patient with Cerebral Palsy: Osteosynthesis Material Failure Three Weeks Postoperative

Nader Fadi, Yazbeck Rime, H. Fares Ali, Sleiman Mohamad Ali, Massaad Dounia , Massaad Antonella , Massaad Raymond

Asian Journal of Orthopaedic Research, Volume 5, Issue 2, Page 309-315

Cerebral palsy (CP) is a group of disorders that affect a person's ability to move and maintain balance and posture. Excessive femoral internal rotation is one of the gait problems encountered and can be corrected by femoral derotation osteotomy.

We present here the case of 14 years old boy, known to have cerebral palsy, with increased femoral anteversion treated with proximal subtrochanteric femoral de-rotation osteotomy fixed with plate and screws.

He experienced a catastrophic failure of the plate. First time revision was done with a dynamic hip screw sliding plate, second time revision was done for pseudarthrosis and consisted  of adding a dynamic compression plate (DCP) on the anterior cortex to increase the fixation stability.

As a conclusion, a robust system should be utilized when trying to osteosynthesis fractures near spastic muscles, and tenotomy should be added whenever needed without hesitation.

Open Access Case Study

Spine Implant Failure after C1-C2 Fixation

Evsukov Alex, Filatov Egor Yu, Burtsev Alexandr, A. Kulikov Oleg

Asian Journal of Orthopaedic Research, Volume 5, Issue 2, Page 202-214

The paper presents two clinical cases of the patients with different congenital craniovertebral junction deformities who developed rare delayed complications after the treatment and provides critical analysis of related literature data. CAAD is a complex multiplanar deformation, whose treatment requires a differential approach and depends on a kind of congenital anomalies and a load placed on instrumentation fixing points. Maximally symmetric positioning of the implants can help to avoid the recurrence or formation of a new anomaly in the postoperative period. A facet joint block prevents the formation of postoperative lateral atlantoaxial dislocation (LAAD).

Open Access Case Study

Glomus Tumor of Finger Often Misdiagnosed as Peripheral Neuropathy: A Case Report

Indra Kumar Gurung, Surakshya Baral, Jhapindra Pokharel, Bhim Sigdel, Anil Regmi

Asian Journal of Orthopaedic Research, Volume 5, Issue 2, Page 164-171

Introduction: A glomus tumor is a benign, rare neoplasm that arises from the glomus body of  palms, digits and soles of the feet. In the absence of visible local lesions or a complete triad, patients often visited different departments of hospitals for pain relief, which delayed diagnosis.

Objective: This paper aims to present the case of a middle-aged female who was previously misdiagnosed with neuralgia, later diagnosed as a case of Glomus tumor right index finger successfully managed by surgical excision.

Case Presentation: 30-year-old female initially managed as neuropathic pain at primary health centre as diagnosed as subungual Glomus tumor of right index finger, which was managed with transungual surgical excision and replacement of nail to prevent with deformity, with clinical improvement in symptoms, no signs of recurrence, and no nail deformity at 2 month follow up.

Conclusion: Glomus tumors are rare and often misdiagnosed due to gross inspection findings. A classic triad of symptoms is more effective at diagnosing than radiological methods. Complete surgical excision by transungual approach is a treatment of choice for subungual tumors.

Open Access Case Study

My Hand, My Survival: Rehabilitating the Hand for Optimal Function

Abiola Olayinka Fafolahan , Wasiu Olawale Afolabi , Kayode Orekoya , Hammed Olaoye Iyiola , Sherif Olawale Owoola , Khadijah Olatoun Afolabi

Asian Journal of Orthopaedic Research, Volume 5, Issue 2, Page 316-322

Background: Compartment syndrome is a medical emergency that needs to be treated right away with surgery to stop further complications.

Case Presentation: A 54-year-old man presented with acute compartment syndrome of the right upper limb. He underwent fasciotomy, and physiotherapy management started immediately after the surgery. The treatment plan aimed to address pain, preserve muscle function, prevent complications post-fasciotomy, preserve range of motion, strengthen affected muscles, and restore function. The treatment involved a combination of therapeutic interventions and treatment plans and was carried out over a period of 3.5 months. The treatment approach involved passive movements, free active exercises, isometric contraction, assisted active exercises, massage therapy, cryotherapy, electrical muscle stimulation, and scar massage. Throughout the treatment period, the patient's progress was closely monitored, and adjustments were made to the treatment plan as needed. By the end of 12th week, there had been a noticeable improvement in the affected upper limb's UEFI-15 score and gross muscle power.

Conclusions: Pain management, muscle function preservation, and limb function restoration were all achieved successfully with physiotherapy management. The successful outcomes seen in this case study highlight the benefit of early diagnosis and prompt intervention of compartment syndrome, as well as a team-based, all-inclusive approach to care that includes physiotherapists, medical experts, and other members of the healthcare team.

Open Access Original Research Article

Hallux Valgus in Adolescents: A Retrospective and Descriptive Study

Karima Atarraf , Hatim Jabri , Mohamed Tazi Charki , Hicham Abdellaoui , Abderahmane Afifi

Asian Journal of Orthopaedic Research, Volume 5, Issue 2, Page 298-308

Hallux valgus is the deviation of the first metatarsal in varus and the big toe in valgus.

Through a retrospective study we analyzed 10 feet managed fr hallux valgus between January 2014 and March 2020. The average age was 14 years with female predominance. Patients reported pain and the deformation. Idiopathic origin was the most frequent. The average of M1P1 angle was 44.08°, the M1M2 angle was 14. 05°.The mean DMAA value was 18.8°, and the mean M1M5 angle was 32.4°.

Sesamoid class 1 was found in six feet (60%), four others had sesamoid class 2 (40%). Seven feet had dislocated or subluxated non-congruent metatarsophalangeal joints with a percentage of 70%. The average medial arch measurement was 110°, the average angle of attack of M1 was 20.87°.

All patients underwent uneventful surgery. McBride surgery was performed on two feet. A stabilized re-axation osteotomy with K-wires associated with a release of the abductor hallux was performed in six feet out of the other eight. In these eight, 40% had a chevron osteotomy, 30% had a Mitchell Osteotomy and 10% had a modified Scarf Osteotomy.

They resumed walking on the heel immediately with a 6weeks boot cast.

The mean value of the M1P1 angle decreased from 44.08° pre-operatively to 15.46° post-operatively with a reduction rate of 64.92%.

Given the immaturity of the child's skeleton, the surgical treatment of hallux valgus must be as innocuous as possible.

Open Access Original Research Article

The Prevalence of Postoperative Wound Infection in Orthopedic Surgery at Bangabandhu Sheikh Mujib Medical College (BSMMC), Faridpur, Bangladesh

Mohammad Shahin Akter, Mst. Maksuda Khatun, Abul Hasan, Shahidul Islam, Mohammed Salim Miah, Md. Azizur Rahman

Asian Journal of Orthopaedic Research, Volume 5, Issue 2, Page 323-329

Background: Surgical site infections (SSI) in orthopaedic surgery are reported to have a prevalence ranging from 1 to 22%. These infections significantly impact various aspects of patient care, including increasing the cost of treatment, prolonging the use and abuse of antibiotics, and raising the levels of morbidity and rehabilitation required.

Aim of the Study: The objective of this study is threefold; firstly, to delineate the occurrence of SSI after elective orthopedic surgeries; secondly, to outline the epidemiological attributes of SSIs, including the timeline of SSI onset and the bacterial agents responsible; and lastly, to determine the autonomous risk factors that correlate with SSI.

Methods: This prospective study was conducted in the Department of Orthopedics, Bangabandhu Sheikh Mujib Medical College (BSMMC), Faridpur, Bangladesh, from June 2021 to July 2022. 

Results: A total of 100 patients participated in the study, and 6 out of 80 cases were diagnosed with an infection at the operative site on postoperative day 5. The overall incidence of infection in this study was 7.50%. The gram-positive and gram-negative bacteria isolated from the surgical site infection were E. Coli and Staphylococcus aureus, respectively. E. Coli was found in 3 cases (42.9%), while Staphylococcus aureus was found in 4 cases (57.1%). Furthermore, we discovered a significant negative correlation between the time of antibiotic administration and pre-operative stay.

Conclusion: Moreover, numerous surgical procedures do not follow standard protocols, and various perioperative situations require modifications to established preventive measures. In our recent study on antibiotic prophylaxis, we found that prophylactic antibiotic treatments should be provided for a diverse range of surgical operations. It was observed that the types of harmful microorganisms and the degree of antibiotic resistance significantly varied among hospitals.

Open Access Original Research Article

The Impact of the COVID-19 Pandemic on the Provision of Minor Orthopaedic Trauma Procedures in Ireland

D. M. Moore, J. P. Gibbons, J. Sorensen, D. P. Moore, J. F. Quinlan

Asian Journal of Orthopaedic Research, Volume 5, Issue 2, Page 138-148

Background: The Covid-19 pandemic has affected healthcare systems worldwide including a reduction in the volume of non-essential procedures and treatments. This study explores the impact on the provision of minor orthopaedic trauma procedures from public hospitals in Ireland during the first wave of the Covid-19 pandemic.

Methods: Administrative data from 2018-2020 on hospital episodes with minor orthopaedic trauma procedures were obtained and grouped into six categories of index procedures. The Covid-19 pandemic was defined from 29th February 2020 when the first case was registered in Ireland until 30th September 2020. The number of admissions, percentage of day cases, and the average length of stay for inpatients were compared with similar periods in 2018 and 2019.

Results: There were 1433 (-27.0%) fewer admissions for the index procedures during the first 30 weeks of the Covid-19 pandemic than during the similar weeks of 2018 and 2019. The proportion of day cases remained largely unchanged (37.7% vs 38.1%) while the average length of stay for inpatients reduced significantly (p=0.006) from 3.1 to 2.7 days during the pandemic.

Conclusion: During the first wave of the Covid-19 pandemic, there was a substantial reduction in the volume of minor orthopaedic trauma procedures and a reduction in the average inpatient length of stay for patients with minor orthopaedic injuries.

Open Access Original Research Article

Efficiency of Therapy with High Concentrations of Topic NSAIDs in Patients with Hip Osteoarthritis

Dmytro Grebeniuk, Serhii Shalyhin, Viktor Pashynskyi

Asian Journal of Orthopaedic Research, Volume 5, Issue 2, Page 179-185

Aims: The aim of the study was to evaluate the effectiveness of therapy with high concentrations of topical NSAIDs in patients with hip osteoarthritis, depending on the volume of local fat deposits.

Materials and Methods: The study included 108 patients with a confirmed diagnosis of hip osteoarthritis. All patients were randomly divided into 2 large groups - according to the criteria for the volume of subcutaneous fat in the hip joint – patients with a skinfold thickness of 2 cm or less (group 1, n=68) and patients with a skinfold thickness of more than 2 cm (group 2, n=40). In addition, according to the used medication, the patients of each group were randomly divided equally into subgroups a (5% Ketoprofen gel) and b (5% Diclofenac sodium gel). The duration of treatment was 14 days. To assess the effectiveness of treatment, we studied the overall tolerability of the prescribed therapy, as well as the quality of life of patients at the time of inclusion in the study and after 14 days.

Results: In group 1 there was a significant improvement in the quality of life on all 5 scales of the questionnaire. When pairwise comparison of the studied parameters after the treatment, in the group of patients receiving the topical Diclofenac, the quality of life on all scales of the questionnaire was significantly better than in patients receiving Ketoprofen. All patients in group 2 showed a slight improvement in the quality of life in all parameters. The change in the studied indicators was not statistically significant and did not depend on the choice of topical NSAIDs.

Conclusion: Diclofenac has been shown to be more effective than Ketoprofen in patients with weak localized fat deposits. The efficiency of both drugs was insignificant in patients with pronounced fat deposits in the hip joint area.

Open Access Original Research Article

Molecular Detection of Bone Sialoprotein-Binding Protein (bbp) Genes among Clinical Isolates of Methicillin Resistant Staphylococcus aureus from Hospitalized Orthopedic Wound Patients

Ikemesit Udeme Peter, Nwankwo Chinenye Emelda, Ezinwanne Blessing Chukwu, Justina Nnenna Ngwu, Henrietta Onyinye Uzoeto, Ezeh Chinonyelum Moneth, Aduaka Oluchukwu Stella, Christiana Inuaesiet Edemekong, Ekuma Perpetua Uzoamaka, Agabus Chidiebube Nwuzo, Ifeanyichukwu Romanus Iroha

Asian Journal of Orthopaedic Research, Volume 5, Issue 2, Page 254-262

Background and Objectives: Methicillin Resistant Staphylococcus aureus (MRSA) is one of the bacteria that are frequently encountered in orthopedic practice causing human skeletal infections due to expression of Genes encoding Microbial Surface Components Recognizing Adhesive Matrix Molecules that aid in microbial invasion of bone. As such, this study was aimed at screening for Bone sialoprotein-binding protein (bbp) Genes among Clinical Isolates of Methicillin Resistant Staphylococcus aureus from Hospitalized Orthopedic Wound Patients.

Methodology: Aseptically, four hundred (400) fracture and post-surgical wound swab samples were collected from orthopedic wound patients and subjected to standard microbiological protocol for isolation and identification of MRSA using Brilliance MRSA II Agar and Double Disc Diffusion Test with inclusion Oxacillin (5μg) and Cefoxitin (30μg). Randomly selected MRSA strains were further screen for Penicillin binding protein 2a (mecA) and Bone sialoprotein-binding protein (bbp) gene by PCR using specific primer.

Results: MRSA had an overall detection rate of 164 (41.0%), with an increase prevalence rate of 86 (21.5%) in post-surgical wound samples, followed by fracture wound samples (78 (19.5%). However, the isolation rate of MRSA was significantly associated with the sample source p value <0.05. Of the ten (10) selected MRSA strain, mecA gene was genetically detected 100 % comprising of 50.0% from postsurgical wound patient (MR1-5) and 50.0% from fracture wound patient (MR6-10) while the bone sialoprotein-binding protein (bbp) gene was identified in 100% of MRSA strain from both post-surgical wound (MR1-5) and fracture wound (MR6-10) patients each accounted for 50.0% of the total amplified gene.

Conclusion: This study report MecA and bbp expression in hospitalized orthopedic wound patients, emphasizing that mecA and bbp detection can be used as a marker of MRSA bone invasion, especially in orthopedic wound infections. To reduce the risk of infection and to halt the clonal proliferation of these virulent strains, a proper wound care/hygiene, comprehensive and ongoing surveillance system that provides epidemiological and genetic information is required.

Open Access Original Research Article

Functional Outcome of Unstable Inter Trochanteric Fractures with Osteoporosis Treated with Type II Proximal Femoral Nail

Roshan Jaiswal, Prathyush Chitithoti, Tatikonda Venkata Jagadish Kumar, Uday Kumar Goud

Asian Journal of Orthopaedic Research, Volume 5, Issue 2, Page 186-194

Introduction: With increasing longevity of the population, the proportion of elderly patients experiencing osteoporosis related complications has significantly increased. The incidence of femoral intertrochanteric fractures has also increased year by year. 45% of all hip fractures are intertrochanteric fractures and 35–40% of these fractures are unstable three or four part fractures and associated with high rates of morbidity and mortality.

Materials and Methods: The present studyis a cohort study to show the Functional outcome of unstable inter trochanteric fractures treated with PFNA II in elderly osteoporotic patients, and to note the radiological union in the treated people

Results: In our study, the mean Age of patients age group is 71-80,6(40%) and 81-90, 6 (40%), followed by 03 (20%) patients were 61-70 years. The means of age is 70.04±12.42. In the present study & observation was done by higher Harris Hip score (HHS). Their intergroup comparison of score showed differences at every single follow-up. Additionally, the minimal blood loss, length of surgery, and a smaller incision, & Average hospital stay revealed no substantial variations.

Conclusion: PFNA2 is a significant advancement in the treatment of unstable trochanteric fractures which has the unique advantages of closed reduction, preservation of fracture hematoma, less tissue damage, early rehabilitation and early return to work. Osteosynthesis using a PFNA2, used in unstable trochanteric fractures, resulted in low rates of clinical complications, excellent stabilization, few mechanical complications and adequate functional results.

Open Access Original Research Article

Non-wedge Technique for Valgus Subtrochanteric Osteotomy in Pediatric Femoral Neck Non-union

Saeed Ahmad, Irfan Qadir, Jahanzeb Mazari, Amer Aziz

Asian Journal of Orthopaedic Research, Volume 5, Issue 2, Page 263-269

Aims: The aim of this retrospective study was to evaluate the clinical and radiological outcomes of using valgus subtrochanteric osteotomy in pediatric femoral neck non-union in terms of Ratliff functional score and time to union respectively.

Study Design: Case Series.

Place and Duration of Study: Ghurki Trust Teaching Hospital Lahore Pakistan. Study conducted between Jan 2016 to Dec 2019.

Methodology: This was a retrospective study of 5 children with femoral neck non-union who underwent osteosynthesis and valgus subtrochanteric osteotomy at Ghurki Trust Teaching hospital between 2016 and 2019. Clinico-demographic profile of patients and functional and radiological outcomes in terms of Ratliff grading and time to union respectively are reported. All patients had a minimum of 2 years followup.

Results: This study included five patients (two males and three females with mean age of 9.8 ± 1.92 years). All patients achieved fracture union, seen within an average of 18 ±6.37 weeks and of the osteotomy site within 13 ± 2.9 weeks. Neck shaft angle improved from average 107 degrees (range 100-110) preoperatively to 137 degrees postoperatively (range 130-140). Pre-operative radiologic signs of AVN was shown in all patients which disappeared completely in 4 patients. Mean limb-length discrepancy decreased from 2.9 cm preoperatively to 0.8 ± 0.57cm post-operatively. According to Ratliff criteria, 4patients had good whereas one patient had fair functional outcome. There were no intra-operative or early post-operative complications recorded in our series.

Conclusion: We report that valgus subtrochanteric osteotomy in non-united femoral neck fractures in children is cost-ef­fective and technically less demanding procedure and is associated with good clinical and radiological outcomes.

Open Access Original Research Article

Importance of Percutaneous Vertebroplasty in the Management of Spinal Metastases

Mohamed Seddik Eddine Akremi, Mehdi Bellil, Souha Bennour, Senda Bellila, Walid Balti, Mohamed Ben Salah

Asian Journal of Orthopaedic Research, Volume 5, Issue 2, Page 149-154

Introduction: Vertebral metastases are clinically manifested by severe pain, pathologic fracture, life threatening hypercalcemia, spinal cord compression and impaired quality of life. Therapeutical strategy depends on several factors such as: life expectancy, general condition of the patient and the number of spinal lesions. Vertebroplasty techniques, especially kyphoplasty, are becoming an increasingly important option for spinal metastases. Recent studies have shown the effect of vertebroplasty on postoperative pain of metastatic origin without prolonged follow-up.

The aim of our work is highlighting the short-term effect of vertebroplasty in the treatment of pain related to vertebral metastases and to study the effect on vertebral stability.

Methods: We conducted a single-centered retrospective study over a period of 4 years including 30 patients affected by spinal metastases without neurological signs with a total of 46 vertebroplasties.

Results: The mean age of our patients was 55.13 years. The average preoperative visual analogue scale (VAS) was 8.46 and reached an average of 2.73 maintained until the last follow-up of 2 years, attesting to the significant decrease in spinal pain (p<0.05).

The average Beck index increased from 0.58 preoperatively to 0.84 postoperatively, with a significant difference (p<0.05).

Angular kyphosis significantly decreased from a mean of 17.8° preoperatively to 7.3° postoperatively at the last follow-up (p<0.05).

Three cases of polymethacrylate (PMMA) cement leakage were noted, with no neurological compromise.

Conclusion: Spinal vertebroplasty techniques are reliable, effective and reproducible in the management of vertebral metastatic lesions, enabling stability with pain control.  

Open Access Original Research Article

A Prospective Study of Four-part Intertrochanteric Femur Fractures Treated with Cemented Bipolar Prostheses in Elderly Patients

Lakhan Pratap, Jitendra Aloria, Satyendra Meena, Mahendra Gosaliya, Ajeet Singh

Asian Journal of Orthopaedic Research, Volume 5, Issue 2, Page 155-163

Introduction: The care of comminuted inter trochanteric femur fractures in the elderly is complicated because to the difficulty of anatomical reduction in osteoporotic bones, the requirement for prolonged immobilization following surgery, and the increased risk of screw cut out in poor quality bone. Prolonged Bed sores, chest infections, and deep vein thrombosis are among problems of immobility. Both morbidity and mortality are increased as a result of reliance and psychosocial side effects.

The Purpose of this Study: “To assess the functional outcome of cemented bipolar hemiarthroplasty in patients over 60 years old with comminuted intertrochanteric femur fractures”.

Materials and Methods: This study was conducted in the Department of Orthopedics, Govt. Medical College, and affiliated groups of hospitals in Kota between 2017 and 2019. The patients were all over 60 years old and had an intertrochanteric fracture that was unstable. Exclusion criteria: Patient is unwilling to undergo surgery and is medically unfit.

Results: The average age in our research was 77.3 years. Hypertension was the most prevalent linked medical issue, accounting for 33% of the total. Cerclage wire was used to keep the pieces of the Greater trochanter together (46.66%). In seven cases, calcar reconstruction was performed (23.33%). The patients were followed up on at six weeks, three months, six months, nine months, and one year after surgery. After 6 weeks, 12 patients were able to walk without assistance, 10 with a cane, and 8 with a walker. Squatting and sitting cross-legged were not recommended for any of the patients.

Conclusion: For older patients with comminuted inter trochanteric femur fractures, the surgery allowed for quick mobilization, early recovery to pre-injury levels, and provided a long-term solution.

Open Access Original Research Article

Outcomes of Osteonecrosis of Femur Head by Core Decompression and Tensor Fascia Lata Based Muscle Pedicle Bone Graft

Sameer Tyagi, Rajiv V. Kulkarni, Buddhadeb Nayak, Anupam Inamdar

Asian Journal of Orthopaedic Research, Volume 5, Issue 2, Page 280-285

Purpose: Osteonecrosis of femoral head (ONFH) is the major cause of musculoskeletal disability. Core decompression (CD) is the most widely used strategy for the management of ONFH but it lacks the ability to increase the vascularization around the necrotic femoral head. So the purpose of the study was to evaluate the outcome of CD with tensor fascia lata muscle pedicle bone graft in ONFH patients.

Methods: This prospective study was conducted on 26 ONFH patients. Core decompression with TFL muscle pedicle grafting methods was used in all the patients. The outcome of the technique was evaluated using Harris hip score.

Results: In this study, the major risk factor ONFH was alcohol intake followed by chronic steroid use. Majority of the patients (57.69%) were in stage III ONFH. The Harris Hip Score was excellent in 14 hips (53.846%), fair in 2 hips (7.692%) and poor in 1 hip (3.84%) respectively. There was a significant increase in post operative Harris hip score as compared to preoperative (86.6 ± 8.0 vs 63.7 ± 6.7).

Conclusion: Tensor fascia lata muscle pedicle grafting along with core decompression is a reliable technique for pain reduction and improved vascularization in necrotic femoral head.

Open Access Original Research Article

Functional Outcome of Operative Management of Femoral Shaft Fractures in Children with Tens (Titanium Elastic Nailing System)

Suday Mukhopadhyay, Bhuvnesh R. Chaturvedi, N. Hanumantha Reddy

Asian Journal of Orthopaedic Research, Volume 5, Issue 2, Page 215-253

Background: Femoral shaft fractures account for 1.6% of all bony injuries in children, usually caused by assault or fall during normal play. Male to female ratio being 2.6:1. Low velocity trauma leads to transverse fractures and high speed trauma causes comminuted or segmental fractures.

In children who are five years of age or younger, early closed reduction and application of a spica cast is an ideal treatment for most diaphyseal femoral fractures.

The preferred method of treatment for skeletally mature teenagers is an antegrade solid intramedullary rod. There is considerable disagreement over the ideal course of care for children aged between the ages of six and sixteen. The assessment and management of patients with femoral shaft fractures in children aged 6 to 14 years old is evolving due to a better understanding of the local anatomy, the impact of treatment, and the biomechanics of fixation techniques.

Study Duration: 1st September 2014 to 1stSeptember 2015 at the Department of Orthopaedics, Calcutta National Medical College Kolkata

Methods and Materials: Nail Selection: Titanium Elastic Nails are available in five diameters: 2.0 mm, 2.5 mm, 3.0 mm, 3.5 mm and 4.0 mm; and are 440 mm in length.

The following sizes were typically used for children of

Average stature:

6–8 years old 3.0 mm nails

9–11 years old 3.5 mm nails

12–14 years old 4.0 mm nails

Two nails of the same diameter were selected so the opposing bending forces are equal, avoiding misalignments. Femoral fractures in children are typically stabilized with two nails inserted in a retrograde manner from medial and lateral entry points above the distal physis

  1. Countouring the nail
  2. Creating the entry points
  3. Insertion of the nail
  4. Reduction of the fracture
  5. Cutting of the nails

After Treatment: The patient was kept non weight-bearing for 2 weeks. During this time a long leg back slab was applied for patient comfort. After 2 weeks the back slab along with the skin sutures were removed. Active knee bending exercises were allowed. The patient was allowed partial weight bearing with axillary crutches after 4 weeks. Radiographs were obtained after 6 weeks and progression to full weight bearing was done depending on the status of fracture and amount of callus formation.

Removal of the Nails: The patient was planned for implant removal after consolidation of the fracture which was on an average of 6 months from the date of injury. Self locking extraction pliers were used for this purpose

Results: During the study period, 30 cases were randomly selected for inclusion in the study following the inclusion criteria mentioned earlier. Cases were managed operatively with internal fixation using titanium elastic nails (TENS). All cases were initially treated by surface traction. Applied at the earliest possible moment. Followed by, the patients underwent proper pre operative investigations and pre-anaesthetic check up followed by the definitive surgical procedure. The age range of the patients in the study was 6-14 years, with a mean of 10.2 years treated operatively by TENS. There is no significant difference in between both groups in terms of demographic data (age, sex), fracture type and pattern, hospital stay and co morbidities at the time of presentation. All fractures in the operative group united clinically by 8 weeks and radiologically by 10 weeks  the difference was statistically significant, proving that patients in the operative group achieved healing milestones at an accelerated pace.

Although there was knee flexion (avg. 131.50 in the operative group were found to be insignificant on statistical analysis. Shortening was found in the operative group (mean 0.1 cm), and the difference was found to be highly significant on statistical analysis. Degrees of angular malalignment in the operative group with means of 1.80.

No major complications were seen in patients.

There is no significant difference in between both groups in terms of demographic data (age, sex), fracture type and pattern, hospital stay and co morbidities at the time of presentation. All fractures in the operative group united clinically by 8 weeks and radiologically by 10 weeks  the difference was statistically significant, proving that patients in the operative group achieved healing milestones at an accelerated pace.

Although there was knee flexion (avg. 131.50 in the operative group were found to be insignificant on statistical analysis. Shortening was found in the operative group (mean 0.1 cm), and the difference was found to be highly significant on statistical analysis. Degrees of angular malalignment in the operative group with means of 1.80.

No major complications were seen in patients.

Conclusion and Recommendations: During the study period, 30 cases were selected to be included in the study which had transverse and short oblique diaphyseal fractures of the femur.30 cases were treated by operative intervention by closed intramedullary nailing with titanium elastic nails.

The age range of the patients was from 6-14 years, with a mean of 8.3 years in the operative group.

Males were more frequently affected than females, the ratio being 2.3:1.

The most common mode of injury was motor vehicle accident (MVA) accounting for 70% of the cases and the rest being falls from height. The left side was more frequently found to be injured (in 60% cases). Most of the cases (in 70% cases) in the operative group had their surgeries completed by the 5th post-injury day.

Open Access Original Research Article

Epedemiology and Long Term Trend of Distal Radius Fracture in Elderly of Sindhudurg, West Cost of Maharashtra, India: A 12 Years Follow Up Study

Raghavendra Shankar Kulkarni, Rachana A. Kulkarni, Aditya P. Kulkarni, Ranjani R. Kulkarni, R. S. Deshpande, SriRam R. Kulkarni

Asian Journal of Orthopaedic Research, Volume 5, Issue 2, Page 172-178

Aims:  The accurate prevalence and trend of distal radius fracture is not well documented in Maharashtra, India. This hospital based study amis to provide authentic incidence rates of this fracture and long term trend in elderly residents of Sindhudurg.

Study Design: Department of Orthopaedics, Government District Hospital, Sindhudurg, Maharshtra, India, between 2000 to 2011.

Methodology: All patients of distal radius fracture, above the age of 50 years treated by one surgeon at one hospital are included in this retrospective study, solely on the final diagnosis mentioned on case paper according to Frykman classification system.

Results: There were 947 distal radius fractures, out of which 644 (66.1%) men. This study notifies the increased incidence of distal radius fracture in elderly men, than in women, contrary to the western hemisphere literature. The incidence was highest in men between 51 to 70 years with almost linear rise up to the end of study period; with a relative risk of 2.2 (95% CI 2.1 to 2.6). A border line evidence of straight rise in women was seen at 71 to 80 years (p = 0.05) with a common odd ratio of 1.1 (95% CI 0.7 to 1.5). The age range 51 to 70 years showed homogeneity (p = 0.21) with 2.1 (95% CI 1.7 to 2.9). A definite increasing trend is observed, during rainy season of June to September months throughout the whole study period with rates as high as for both sexes, 423(43.4%) ( p>0.001 )

Conclusion: This long term study reported increasing trend in the incidence of distal radius fractures in both elderly men and women. The incidence was highest in 51 To 70 years age group with highest number of low energy falls. This will be of great help for the future benefit risk ratio of fragility distal radius fracture prevention efforts.

Open Access Review Article

Revolutionizing Arthritis Treatment: The Synergy of iPSCs and Extracellular Vesicles-based Acellular Therapies for Joint Tissue Repair

Owen R. Thornton, Wenjun Li

Asian Journal of Orthopaedic Research, Volume 5, Issue 2, Page 330-335

This review discusses the current state of arthritis treatment and the limitations associated with traditional approaches. The review then explores the potential of induced pluripotent stem cells (iPSCs) and extracellular vesicles (EVs) for joint tissue repair. The use of iPSCs and EVs together in acellular therapies has the potential to provide a safe and effective treatment option for joint tissue repair. The review examines the benefits of these therapies and discusses future research directions, including the use of bioinspired EV-mimicking nanoparticles and the modulation of the immunogenicity of donor iPSCs. The review also addresses the potential ethical implications of these therapies and proposes solutions for addressing these concerns. Overall, this review suggests that iPSCs and EVs-based acellular therapies could revolutionize regenerative medicine for arthritis treatment, providing a promising avenue for future research.

Open Access Review Article

Anatomical and Surgical Basis for the Treatment of Paralytic Knees

C. Elkassimi, S. Rouadi, M. Fadili, E. Bachkira, A. M. Abdullah, I. Jadib, O. Hadad, K. Tabbak, M. A. Kharoub, A. Rafaoui, A. Messoudi, M. Rahmi, M. Rafai

Asian Journal of Orthopaedic Research, Volume 5, Issue 2, Page 270-279

This review is to highlight the anatomical and surgical basis for the treatment of paralytic knees that lead to a grave functional handicap because of its intermediate situation in lower limb.

 Paralytic knee disease affects muscular balance and osteoarticular growth to the point of sometimes compromising the possibility of standing and walking.

Combined with a good knowledge of the main etiologies (Poliomyelitis, myelomeningocele and cerebral palsy), it enables the bases of the orthopedic treatment to be defined. Consequences related to paralytic knee desease may lead to neuroorthopaedic deformities in the joints.

Orthopaedic surgical treatment of the consequences of knee paralysis is varied both in terms of the diversity of the surgical techniques that can be carried out (tenotomies, lengthenings, transfers, osteotomies...) and the patient’s profile. It must essentially meet functional and not morphological.