Open Access Case Report

Ischiatic Dislocation of the Hip Associated with an Ipsilateral Femoral Shaft Fracture: A Case Report and Literature Review

Z. F. Zengui, O. El Adaoui, A. Rguibi, Y. El Andaloussi, A. R. Haddoun, D. Bennouna, M. Fadili

Asian Journal of Orthopaedic Research, Page 34-39

Introduction: Ischiatic dislocation of the hip associated with an ipsilateral femoral shaft fracture is unusual. It represents a real therapeutic challenge.

Case Report: We report the case of a 26-year-old drug-addicted patient who fell from the 4th floor. This fall resulted in severe polytrauma, with an ischiatic dislocation of the left hip associated with a fracture of the left femoral shaft, besides a displaced open fracture of the left humerus, a fracture of the medial malleolus, a fracture of the calcaneum and a fracture of the sacrum. An emergency reduction of the hip dislocation was performed 3 hours after admission to the operating room by external manoeuvres of the hip dislocation. Osteosynthesis of other lesions was performed 24 hours after the patient’s hemodynamic and respiratory stability with the anterograde femoral nail. Early mobilisation of the limb joints without full weight bearing for up to 2 months. The patient returned to his professional activity pre-injury after 4 months.  

At a 2-year follow-up postoperatively. The patient considered the evolution satisfactory. X-rays noted good consolidation of the fractures. There was no evidence of avascular necrosis on radiographs after 2 years.  

Conclusion: The combined injury of a femoral shaft fracture with a homolateral ischiatic dislocation of the hip is extremely rare. The emergency in an unstable patient with femoral head dislocation is the reduction of the femoral head to minimise the risk of avascular necrosis in the young adult.

Open Access Original Research Article

Acute Pain and Loss of Shoulder Movement - How to go about? An Evidenced Analysis

S. S. Subramanian

Asian Journal of Orthopaedic Research, Page 1-7

Acute pain in shoulder, loss of active shoulder movement, in a diabetic, hyperlipidemia, endomorph subject gives risk to a variety of clinical conditions as under lying cause to be identified and treated with medication. As many associated conditions such as vertebrobasilar insufficiency, atherosclerosis, cervical myelopathy could be contra indications to many physiotherapy modalities such as traction and manual therapy procedures.

48 year old diabetic women, post hysterectomy, hyper lipedemia suddenly complaining of acute pain with total loss of ability to use right shoulder limiting her daily activities and her quality of life, were discussed. This study with due scientific evidence on importance of multidisciplinary care, using analytical assessment, arriving at proper diagnosis and treatment followed by specific physiotherapy were highlighted.

As orthopaedic and neurologic advice on investigations, evaluation with due medication, physiotherapeutic rehabilitation were carried with reasonable recovery in couple of months period later. The results were discussed on Numerical pain rating scale and her subjective shoulder function scores. Due clinical decision making skills, early intervention by other health care experts enable proper, timely health care delivery with team work was the core of this research.

Open Access Original Research Article

Implant Removal: Considerations in a Nigerian Teaching Hospital Setting

K. M. Onuoha, U. Obong, O. Alade, I. Owolabi

Asian Journal of Orthopaedic Research, Page 8-14

Background: Orthopedic implants removal has several indications and may sometimes be a cause of controversy. Once there is union between ends of fractured bone, the implant stopped being important and can be removed. However, there are several considerations before and after removal including patient’s choice, giving back the implant to the patient. Our study aimed to identify various indications and considerations for implant removal in a Nigerian Teaching setting.

Methods:  Data were extracted from the operation register and patients’ case folders on bio-data, diagnosis, type of surgical procedure, site of surgery, dates of surgery and removal of implant, indication for removal. Patients with complete medical record were included in this study.

Results: A total of 12 patients were studied, with 2 males and 10 females.  There were 3 Pediatric patients aged 7, 10 and 18 months. Completion of therapy and peri-implant infection were the major consideration for removal of implants. We also found out that the most common implant at our setting was K-wire (41.7%) while femur bone was the major site of implant.

Conclusions: Peri-implant infection, completion of therapy in case of pediatric patients were the major considerations for implants removal. The femur was the most involved bone, all patients saw the implant after removal and this was documented.

Open Access Original Research Article

Surgical and Functional Outcome of Early Mobilization in Proximal Tibial Fracture

Amey R. Gursale, Rohit S. Kaware, Vaibhav U. Mesare, Amey M. Borse, Sushant S. Tuse, Aamir Matin, Saurabh S. Dhamdhere

Asian Journal of Orthopaedic Research, Page 15-24

Background: The major cause of proximal tibial fractures attributes to road traffic accident, dominated by male gender with younger age group from high energy trauma. With advancement in newer surgical techniques, improvement in the quality of implants, better soft tissue handling during surgery, and early mobilization in the form of assisted and supervised physiotherapy; the results of surgical outcome are improving. We aim to study clinical and functional outcome after surgery with introduction of early mobilization in various types of Proximal Tibial fractures in terms of range of motion and its effect on operative construct.

Methods: This is prospective observational study of 68 cases of Proximal Tibia fractures with 53(77.9%) males and 15(22.1%) females using suitable implants and initiating early physiotherapy from day 2. Follow up at 3rd and 6th week was done to assess the outcome.

Results: Early initiation of physiotherapy showed significant association with improvement in range of motion with choice of implant at 3rd week (p value -0.039) and at 6th week (p value-0.000) and type of fracture as well.

Conclusion: The early mobilization after fixation of proximal tibial fractures helps in improving the range of motion of the knee joint, strength of quadriceps and hamstrings. Since Schatzker type V and VI are more severe than Schatzker type I and II the outcome also varied with improved results seen in later than the former.

Open Access Original Research Article

Osgood Schlatter’s Disease in Teaching Hospital Setting: A Case Series

Kelechukwu Onuoha, Obong Udemeobong, Owolabi Ife, Alade Oluwaseun

Asian Journal of Orthopaedic Research, Page 25-33

Background: Osgood Schlatter disease (Tibial Apophysitis) is a disease of the musculoskeletal system often observed during the bone growth phase in adolescents. It is an inflammation of the tibial tuberosity just below the knee where the patellar tendon attaches to the tibia. 

Aim: The aim of this study was to assess the major presenting complains, affected knee and treatment offered to these patients.

Methods:  This is retrospective study as data was extracted between December 2020 and January 2022 from the medical records and patients’ case folders on bio‑data, presenting complains, examinations carried out and diagnosis made. Presenting complains, affected knee, and treatment offered were the key variables observed. Only files of patients with complete medical records were included in this study. Descriptive statistical analysis was followed to determine frequencies and percentages.

Results: A total of 8 cases of OSD were extracted. Two cases (25%) were 14 years. We also had cases of 18 and 19 years of age included. About 62.5% of the children were females while 37.5% were males. Majority of these children presented with anterior  knee pain (87.5%) while only one child presented with swelling at the knee (12.5%). 75% had OSD on left knee while only 12.5% had it on right and both knees. Most common treatment offered to this patients was lifestyle modifications and oral analgesics.

Conclusions: OSD is a very rare condition and should be considered by physicians in any adolescent with chronic knee pain.