Open Access Case Study

Complex Lisfranc Fracture: Bidirectional Cuneiform Dislocation with Successful Closed Reduction: A Case Report

Timothy K. Summers, Benjamin D. Sookhoo, Robert Shelley, William Rosenblum

Asian Journal of Orthopaedic Research, Page 1-7

Aim: Lisfranc fractures with cuneiform displacement are rare, commonly involving only a single cuneiform dislocation. Literature is limited in multi-cuneiform fracture dislocations. This case report elaborates on treatment of aLisfranc injury with concurrent dorsomedial and plantar dislocations of the medial and intermediate cuneiforms, respectively.

Presentation of Case: A 35-year-old male was diagnosed with a Lisfranc fracture with bidirectional dislocation of the medial and intermediate cuneiforms following a motor vehicle accident. The injury was reduced successfully with manual retraction, midfoot manipulation, and Kirschner wire fixation in the operating studio.

Discussion / Conclusion: Closed reduction and percutaneous pinning are sufficient for reduction in this injury, decreasing morbidity and complications associated with open reduction. Given the nature of our approach, and the distinctiveness of this particular Lisfranc variant, we offer an original methodology to expand on existing literature.

Open Access Original Research Article

Functional Outcome of Giant Cell Tumor of Distal End Radius Treated with Excision and Fibular Bone Grafting

Nitin S. Patil, Amit B. Garud, Vijaysinh Patil, Vishal Sharma, S. V. Goutam

Asian Journal of Orthopaedic Research, Page 1-8

Introduction: Giant Cell Tumors (GCT) comprise about 4-5% of all primary bone tumors and about 20% of benign bone lesions. GCT commonly affects the ends of long bones. The lower end of the radius is the third common site to be affected. The distal radius plays a significant role in  the  radio-carpal  articulation  and  hence  in  the  function  of  the  hand.  Various treatment modalities are advocated in the literature.  We have done wide excision and proximal fibula bone graft with temporary wrist arthrodesis by 2 different procedures.

Materials and Methods: A prospective study including 6 cases of giant cell tumor of distal end of radius was conducted in KIMS, Karad from 2015 and 2018. All patients were evaluated preoperatively with plain radiograph and MRI of involved wrist. All the 6 patients were operated with wide excision, autogenous non-vascularised fibular graft and temporary wrist arthrodesis. Follow up included clinical and radiographic assessment and functional assessment using the Disabilities of the Arm, Shoulder and Hand (DASH) score.

Results: The mean follow-up period was 24 months (20–27) months. All patients achieved radiological union after a mean of 16weeks (14–20) weeks. The mean active range of movement in the operated wrists was 45º dorsiflexion, 15º palmar flexion, 10º radial deviation, 14º ulnar deviation.

Conclusion: Wide excision and proximal fibula bone graft with temporary wrist arthrodesis has been found to be an effective method of treatment for Campanacci grade 2 Giant cell tumor of distal end radius.

Open Access Original Research Article

Effects of Ergonomic Training and Active Exercises for Non – Specific Work Related Upper Extremity Musculoskeletal Disorders in Women Working in Video Display Units

K. Saravanan, Vishnupriya ., Hemalatha ., Kamali ., Isaac Prem Kumar

Asian Journal of Orthopaedic Research, Page 1-12

Background: Work related upper extremity musculoskeletal disorders (WUEMSD’s) are common causes of pain and functional limitations of upper extremity and it can lead to significant distress and disability in women working in video display units (VDU’s).

Objective: The purpose of this study was to examine whether Ergonomic Training (ET) or Active Exercises (AE) would be more effective in decreasing pain and improving disability in women with WUEMSD’s working in VDU’s.

Methodology:  40 women with WUEMSD’s were allocated into two groups. Ergonomic Training Group (ETG) received Ergonomic Training (n=20) and active exercise group (AEG) received Active Exercises Training (n=20) for 45 minutes on first contact session only. Ergonomic booklet was given to ETG and exercise booklet was given to AEG separately. They were advised to adhere to ergonomic advices and active exercises for 45 minutes/day for 4 months regularly based on booklet. Subjects were initially assessed prior to randomization, and at 2nd and 4th month follow-up. The following variables were evaluated: Pain and disability of upper extremity using NPRS and Quick DASH score respectively.

Results: Although both groups exhibited improvement in pain and disability at the 2nd and 4thmonth follow-up sessions (p<.05) compared with baseline measures, but there were significant differences between groups only on pain outcome in AEG, whereas no significant improvement noted between groups on disability (p>.05).

Discussion and Conclusion: The findings of this 4 month follow-up study allow us to conclude: Both groups improved on pain and disability at 2nd and 4th month follow-up assessments. These findings indicate that active exercises group is more effective in relieving UE pain, whereas no significant difference was found between the ergonomic training group and active exercises group in decreasing disability.

Open Access Original Research Article

Comparison of Myofascial Release, Muscle Energy Technique and Cervical Manual Therapy in Postural Neck Pain

Adarsh Ashok, M. Suganya, B. Arun

Asian Journal of Orthopaedic Research, Page 1-6

Globally neck pain has become common health problem in younger generations. Neck pain occurs due to various pathological reasons. Even though there is variety of management protocols to alleviate the neck pain, their efficacy is still not clear. This study includes three different perspectives of manual therapy technique on the postural neck pain. This study is a single blinded randomized controlled trial. 81 volunteers with postural neck pain were selected randomly. They all underwent various evaluation procedures by a blinded assessor. All the participants were divided into three groups with 27 volunteer in each. Group I underwent Myofascial release therapy (MFRG), Group II underwent Muscle energy technique (METG) and Group III underwent Cervical manual therapy (CMTG). All the treatment underwent for 8 weeks duration and their lateral flexion range of motion, disability and proprioception were measured using goniometer, neck disability index and repositioning error.  The result of the study analyzed through SPSS 20.0, it shows that there was no significant difference between the groups in post treatment values, F value for the range of motion is 4.70, Disability is 0.11 and proprioception is 8.71. So this study concluded that there was no difference in improvement of variables following all three modalities.

Open Access Original Research Article

The Idiopathic Clubfoot: Relationship between Patient’s Gender and the Degree of Severity of the Deformity

Chukwuemeka Okechukwu Anisi, Innocent Egbeji Abang, Joseph Effiong Asuquo, Pius Unimke Agweye

Asian Journal of Orthopaedic Research, Page 1-6

Background: The prevalence of the idiopathic clubfoot has been largely reported to be higher in male patients. However, the existence of any relationship between the gender of patients and the degree of severity of the deformity is yet to be established. This study was designed to determine if there is any relationship between the gender of idiopathic clubfoot patients and the degree of severity of deformity.

Methods: Records of all idiopathic clubfoot patients aged 2 years and below who presented at the clubfoot clinic of the University of Calabar Teaching Hospital between January 2013 and March 2019 were reviewed. The degree of deformity of each affected foot based on the ascribed Pirani score at presentation was graded as ‘Less Severe’ for scores less than or equal to 4.0, and ‘More Severe’ for scores greater than 4.0. For the purpose of data analysis, patients were categorized into 2 groups, ‘Male Idiopathic Clubfoot’ and ‘Female Idiopathic Clubfoot’ groups. Statistical analysis was done using IBM SPSS version 22.0.

Results: Median total Pirani score and mean total Pirani score were higher for male patients. The degree of severity of deformity for unilateral cases was evenly distributed irrespective of gender, while for bilateral cases, the degree of severity was proportionately more severe for male patients, and evenly distributed for female patients (p=0.514).

Conclusion:  In this study, the researchers did not find any significant relationship between gender and the degree of severity of the idiopathic clubfoot.