Open Access Case Report

Percutaneous Retrograde Screw Fixation of the Acetabulum: A Case Report

Mohamed Seddik Eddine Akremi, Mehdi Bellil, Majdi Ben Hnia, Senda Bellila, Walid Balti, Mohamed Ben Salah

Asian Journal of Orthopaedic Research, Page 28-32

Introduction: Percutaneous screw fixation techniques for pelvic fractures are mainly described in the management of posterior arch fractures. More recently, improved imaging technology and means for closed reduction have meant that percutaneous techniques have gained popularity in the treatment of acetabular fracture.

The objective of this study is to evaluate the feasibility and interest of percutaneous screw fixation in minimally displaced acetabular fractures.

Observation: We present the case of an 18-year-old female patient with a psychiatric history who was a victim of defenestration.

The radiological exam revealed a fracture of the right sacral ala associated with a minimally displaced T fracture of the left acetabulum. The patient had a percutaneous right sacroiliac screwing and a percutaneous retrograde screw fixation of the left acetabular posterior column. A psychiatric follow-up was carried out. Touch-down weightbearing is allowed for the first three weeks with crutch. The postoperative course was simple. A postoperative CT scan confirmed the correct placement of the screw. Support was allowed after 45 days. No complications were observed at the last 12-month follow-up.

Discussion:  Orthopedic treatment of minimally displaced or nondisplaced acetabular fractures provides good radiological results but does not allow early mobilization and rehabilitation and exposes to decubitus complications. Percutaneous retrograde screw fixation is a reliable and reproducible technique that allows rapid ambulation while avoiding the complications of conventional surgery, such as bleeding, vascular and nerve damage, and heterotopic ossifications.

Conclusion: Percutaneous acetabular screw fixation is a safe and reliable technique for the management of non-displaced and minimally displaced acetabular fractures.

Open Access Short Research Article

The Safety of Early Weight Bearing Following Fixation of Displaced Bimalleolar Ankle Fractures

Rajesh Kishanrao Ambulgekar, Pritesh Kothari, Parag Kulkarni, Rahul Sudhir Agrawal

Asian Journal of Orthopaedic Research, Page 6-11

The most common fractures in adults are the ankle fracture accounting for incidence up to 173 occurrences per 1,00,000 people per year. Ankle fractures which are displaced, are commonly treated with ORIF with variable regimens available. Various authors have shown a link between clinical outcome and postoperative radiography. After open reduction and internal fixation (ORIF) of displaced bimalleolar ankle fractures, this paper compared early weight bearing (EWB) to late weight bearing (LWB) to determine union rates after operation, hardware loosening rate, medial clear space on x-ray, and functional outcome. This study found that EWB did not increase markers of outcome failure 3 weeks after surgery compared to 6 weeks of NWB which is considered the gold standard of care to enable healing, good range of motion, reduced risk of muscle weakning and bone osteoporosis, return more quickly for day-to-day living activities and improve postoperative rehabilitation.

Open Access Original Research Article

Study of the Functional Outcome of Arthroscopic Management of the Meniscal Injury in Knee Joint at Tertiary Care Centre

Rajesh K. Ambulgekar, Pritesh Kothari, Parag Kulkarni, Mahesh Deshmukh

Asian Journal of Orthopaedic Research, Page 1-5

Background: Most common knee injury in sportsperson and athletes is meniscal injuries. Other than sports most common reason road traffic accident and person working in mines, mainly it is due to rotational injuries of knee joint. Such meniscal tears or injuries are repaired by surgical management which involves open surgery, arthoscopic surgery, meniscectomy etc, it is seen that of all the total surgical management done meniscectomy is done among 66 per 100,000 population per year.

Aim and Objective: To evaluate the effectiveness of arthroscopy in the diagnosis and management of meniscal injuries.

Material and Methods: This prospective study was carried out among patients with meniscal injuries of knee joint and getting admitted under orthopaedic department at tertiary care center. Study was carried out for a period of one and half year. Mainly all cases having meniscal injury and showing meniscal lesion on MRI findings were studied. Patients aged between 18-80 years with clinically suspected meniscal injuries and suggestive MRI findings of meniscal lesion were included in the study. All patients not willing to participate, having infection around knee, having lower leg fractures were not studied. Patients with both clinically suspected and MRI diagnosed meniscal injury were admitted. Data analysis was done with the help of appropriate software version. Quantitative data was presented with the help of mean, standard deviation, median and comparison among study group was done with the help of unpaired T test. Qualitative data was represented with frequency and percentage tables, association among study parameters was assessed with the help of chi- square test. P value less than 0.05 is taken as significant level.

Results: Mean age in years was 48.56+6.43, ranging from 51 to 73 years. Majority 53.33% were females. Common mode of injury was road traffic accident (56.6%). Medial meniscus was commonly involved (73.3%). Applying multiple regression to KOOS score r2 value is 0.9 and p value was zero.

43.4% cases showed good functional outcome, 36.6% showed excellent and 20% showed fair outcome. Complications were seen among 17% cases.

Conclusion: present study concludes that as meniscal tear is very common injury among adults. This should be diagnosed and treated at earliest. Arthroscopy gives good post-operative results. The functional outcome is good in arthroscopy treated patients and complications noted were also very less. So, arthroscopic meniscal repair can be considered as a good operational tool for meniscal repair.

Open Access Original Research Article

Early Diagnosis of Acute wound Infection in Orthopaedic Trauma using CRP and Serial Periwound Skin Temperature Monitoring by Infrared Thermoradiography

Amalu Joy, Pradeoth Mukundan Korambayil, Prashanth Varkey Ambookan

Asian Journal of Orthopaedic Research, Page 12-19

Background: Infrared imaging allows non-contact, non-radiating, non-invasive investigation of biological systems, both in preclinical research settings and in the clinical assessment of patients. Quantitative measurement of periwound skin temperature using a reliable infrared camera can assist the wound care practitioner with early identification of deep or spreading infection, allow for timely intervention, and help to monitor ongoing treatment response.

Aim: To assess the wound healing in orthopaedic trauma using infrared camera as an adjunct in clinical practice.

Methods: Prospective observation study of 40 patients with acute wound managed in a tertiary centre from December 2018 to October 2019. Infrared camera used as an adjunct along with other routine blood investigations to assess the healing of these wounds during the course of hospital stay. All skin temperatures were documented using a handheld infrared camera under consistent environmental conditions on the day of dressing. Wound infection was identified using the combination of a serial CRP value and clinical judgement.

Results: Out of 40 patients, 28 cases were post operative wounds and none of them developed any complications. The remaining 12 cases were post traumatic, in which 4 developed infections. These cases were identified by infrared camera in correlation with CRP and other clinical parameters.

Conclusion: Infrared thermography can act as an adjunct in acute post traumatic and post-surgical wound to monitor healing. It cannot replace an experienced clinician’s assessment and judgement based on individual patient and wound factors.

Open Access Original Research Article

Assessment of Percutaneous “K-wireless” Pedicle Screw Fixation Technique

Mohamed Seddik Eddine Akremi, Mehdi Bellil, Chedi Saadi, Cherif Kammoun, Senda Bellila, Mohamed Ben Salah

Asian Journal of Orthopaedic Research, Page 20-27

Percutaneous spinal pedicle screw fixation is a mini invasive technique initially described by Magerl in 1977 [1] using guide wires. The original technique is decribed with use of k-wires which is frequently associated with breakage or recoil during tapping which can extend operating time in often fragile patients and increase radiation exposure in the medical team. Faced with these challenges, we detail our experience with percutaneous k-wireless pedicle screw fixation.

We carried out a retrospective study from January 2018 to December 2020. We collected K-wireless percutaneous pedicle screw fixation performed between the thoracolumbar hinges including T11 up to L5. The positioning of the screws was judged by a postoperative CT scan with grades ranging from A to D: A = intra-pedicle path or "in out in" extra canal. B = Intra-canal path <2 mm, C = Intra-canal path between 2-4mm, and D = Intra-canal path> 4 mm. The operating time, the exposure dose of irradiation and the complications related to the path of the screws were also noted.

A total of 200 screws in 42 patients were collected. A postoperative CT scan was performed in all our patients. 188 screws were grade A. 9 screws were grade B. 2 screws were grade C without clinical consequences and 1grade D symptomatic by an irritation of the left L5 root having required a surgical resumption and the change of the path of the screw. The average time for screw placement was 5.62 minutes with an average exposure dose of 7.6 +/- 1.2 mRem and an irradiation time of 1.2 minutes.

Results of this study showed that lumbur percutaneous k-wireless pedicule screw fixation under fluoroscopic control is achievable with improved operating time and reduced exposure of the medical team.