Problems and solutions for orthopedic surgeons during COVID-19 pandemic

Vol 35 | Issue 2 | May-Aug 2020 | page: 53-61 | Sandeep Kumar¹, Rajesh Arora¹, Arvind Kumar¹, Surabhi Vyas², Shilpee Kumar³, Priyanka Arora⁴, Owais Ahmed Qureshi¹, Javed Jameel¹


Authors: Sandeep Kumar¹, Rajesh Arora¹, Arvind Kumar¹, Surabhi Vyas², Shilpee Kumar³, Priyanka Arora⁴, Owais Ahmed Qureshi¹, Javed Jameel¹

¹Department of Orthopaedics, Hamdard Institute of Medical Sciences & Research, New Delhi, India
²Department of Radiodiagnosis, AIIMS, New Delhi, India
³Department of Microbiology, VMMC & Safdarjung Hospital, New Delhi, India
⁴Department of Obstetrics & Gynaecology, ESIC Medical College, Faridabad, Haryana, India

Address of Correspondence:
Dr. Rajesh Arora
Hamdard Institute of Medical Sciences & Research, New Delhi, India
Email: rajeshmamc@gmail.com


Abstract:

Background: SARS-Cov-2 is believed to have infected over two million humans to date. Lack of complete knowledge about the epidemiology of this virus and doubts about perioperative management of orthopedic patients is further curtailing patient care. This review article discusses the pertinent virology and relevant precautionary practices that help in reducing the risk of contamination of health care workers from an orthopedic point of view.
Methodology: The review was prepared by authors belonging to different disciplines of health care. Recent PubMed-based literature and national and international guidelines related to the CoViD-19 pandemic and its implications on orthopedic practice were reviewed.
Result: Elective surgeries should be avoided. All patients undergoing surgical procedures should be CoViD-19 tested whenever possible. CT chest may be used as a screening tool when CoViD-19 testing is not available considering the risk of exposure to healthcare workers and setup; and higher perioperative mortality (if the patient tests positive later). A full personal protection kit should be used in all surgical cases. Aerosol generating procedures should be avoided. Safety measures should be taken during the shifting of patients to prevent contamination of health care setup and workers. Biowaste from the CoViD zone should be properly segregated and well labeled.
Conclusion: Orthopaedic surgeons should be well updated about the CoViD-19 disease, and should help and support regional policies for both containment and mitigation measures. Simultaneously, one should triage his/her patients in order to use available resources with maximal efficiency without contaminating other patients, healthcare setup and its workers.
Keywords: Orthopaedic surgery; CoViD-19; Pandemic; Perioperative management; Aerosol generating procedures (AGPs), SARS-CoV-2, Orthopaedic trauma, Personal Protective Equipment (PPE), Preoperative workup; Postoperative management.


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How to Cite this Article: Kumar S, Arora R, Kumar A, Vyas S, Kumar Shilpee, Arora P, Qureshi O A, Jameel J | Problems and solutions for orthopedic surgeons during COVID-19 pandemic. | Journal of Bone and Joint Diseases | May-Aug 2020;35(2): 53-61.


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Giant periosteal chondroma of proximal humerus extending on both sides of axillary nerve managed by surgical excision through deltoid split approach via shoulder strap incision : A case report

Vol 35 | Issue 2 | May-Aug 2020 | page: 50-52 |  Kumar Keshav¹


Authors:  Kumar Keshav¹

¹Apex Trauma Centre, Sanjay Gandhi Post Graduate Institute of
Medical Sciences,Rae Bareli road, Vrindavan Yojna, Lucknow, U.P.

Address of Correspondence:
Dr. Kumar Keshav,
Apex Trauma Centre, Sanjay Gandhi Post Graduate Institute of Medical Sciences,Rae Bareli road, Vrindavan Yojna, Lucknow, U.P., PIN- 226029
E-mail: keshav4700@yahoo.co.in


Abstract:
Periosteal chondromas are relatively rare (<2%) amongst the benign bone tumours and giant periosteal chondromas (size in largest dimension >5 cm) are rarer still. It is often confused radiologically with more aggressive malignant tumours of bone. This case report is about a giant periosteal chondroma of the left proximal humerus in a 22 year old male wherein axillary nerve was passing through almost the mid of the lesion. Deltoid split approach via Edinburgh Shoulder strap incision was used to access the tumour which was then removed by marginal excision and intralesional curettage. Axillary nerve was preserved. Histopathologically, there was no signs of malignancy and the diagnosis of periosteal chondroma was confirmed. At 9 months of follow-up, clinicoradiologically there are no signs of recurrence, patient is asymptomatic and performing his normal routine activities.

Keywords: Giant periosteal chondroma, Shoulder strap incision, Axillary nerve


References

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How to Cite this Article: Keshav K | Giant periosteal chondroma of proximal humerus extending on both sides of axillary nerve managed by surgical excision through deltoid split approach via shoulder strap incision : A case report | Journal of Bone and Joint Diseases | May-Aug 2020;35(2):50-52.


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Giant cell tumour of proximal radius – A rare case report

Vol 35 | Issue 2 | May-Aug 2020 | page: 4-49 |  Rohit Nath¹, Deepti Gupta¹, Rajendra Nath¹, Vijay Shankar Sharma¹


Authors: Rohit Nath¹, Deepti Gupta¹, Rajendra Nath¹, Vijay Shankar Sharma¹

¹Department of Orthopaedics, GSVM Medical College & LLR Hospital, Kanpur, UttarPradesh, India.

Address of Correspondence:

Dr. Rohit Nath,
Department of Orthopaedics, GSVM Medical College & LLR Hospital, Kanpur, UttarPradesh, India.
E-mail: nath.ortho@gmail.com


Abstract:
The giant-cell tumour was recognized more than a hundred years ago by Sir Astley Cooper(1818). The most frequently affected segments are sequentially the distal femur, proximal tibia and the distal radius. But involvement of proximal radius is rare. Not more than ten cases in the world literature have been reported so far. We are reporting a case of histologically proved giant cell tumour of proximal radius which was treated operatively by wide resection of tumour and reconstruction of radio-humeral and superior radio-ulnar joint using proximal fibula as autograft with preservation of annular ligament and elbow and superior radio ulnar joint movements. This form of treatment has not been reported in the literature so far. The case is therefore being reported for its rare site and innovative method of treatment.

Keywords:  Giant cell tumour, proximal radius, fibular grafting


References

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How to Cite this Article: Nath R, Gupta D, Nath R, Sharma VS | Giant cell tumour of proximal radius – A rare case report | Journal of Bone and Joint Diseases | May-Aug 2020; 35(2): 47-49.


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To analyze the clinical and functional outcome in patients undergoing an arthroscopically assisted ‘mini open repair’ of rotator cuff tear

Vol 35 | Issue 2 | May-Aug 2020 | page: 42-46 |  Alok Gupta¹, Rajendra Kumar Beniwal², Saumya Agarwal², Shivank Prakash¹


Authors: Alok Gupta¹, Rajendra Kumar Beniwal², Saumya Agarwal², Shivank Prakash¹

¹Department of orthopaedics, Haryana Multispeciality Hospital, Sonipat, Haryana, India.
¹Department of orthopaedics, Central Institute of Orthopaedics, VMMC and Safdarjung Hospital, New Delhi, India.
¹Department of orthopaedics, Sports Injury Centre, VMMC and Safdarjung Hospital, New Delhi, India.

Address of Correspondence:
Dr. Saumya Agarwal
Central Institute of Orthopaedics, VMMC and Safdarjung Hospital, New Delhi, India.
Email Id- saumyathecalyx.agarwal@gmail.com


Abstract:
Background: A rotator cuff tear is one the most frequent shoulder lesions that require surgical treatment. Methods: 30 patients within the span of 2 years underwent mini open repair for the rotatory cuff tear diagnosed with the help of noninvasive imaging. Pre-operative evaluation of shoulder function was done using the University of California Los Angeles [UCLA] scale. Results: There was sequential improvement in pain, which was significant at 9 to 18 weeks and 18 to 24 weeks interval. There was sequential improvement in the range of motion. The mean score for function was pre-operatively was 5.86. Post-operatively, the mean score was 6.13 at 9 weeks, 7.20 at 18 weeks and 9.60 at 24 weeks. After final UCLA score at 24 weeks sixteen patients (53.33%) were rated as having excellent result, twelve patients (40%) as having good result, and two (6.66%) as having poor result. 28 out of the 30 patients were satisfied with the overall result.
Conclusion: Thus, when comparing mini-open and traditional open methods of rotator cuff repair, it appears that outcomes do not significantly differ. However, the advantages of mini-open repair, which include preservation of the deltoid origin, lower peri-operative morbidity, enhanced cosmesis, shortened rehabilitation, and arthroscopic evaluation of the glenohumeral joint for additional pathology, make it an overall superior method.
Keywords: Rotator cuff tear, Arthroscopy, Shoulder mini open repair


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How to Cite this Article: Gupta A, Beniwal R A, Agarwal S, Prakash S | To analyze the clinical and functional outcome in patients undergoing an arthroscopically assisted ‘mini open repair’ of rotator cuff tear. | Journal of Bone and Joint Diseases | May-Aug 2020; 35(2): 42-46 .


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Functional outcome of arthroscopic ACL reconstruction with quadrupled hamstring tendon graft and fixation with metallic screw

Vol 35 | Issue 2 | May-Aug 2020 | page: 36-41 | Sunil Kumar¹, Harsh Singh¹, Prashant Pratap Singh¹, Yogesh Kumar¹, Satyendra Verma¹, Harish Kumar¹


Authors: Sunil Kumar¹, Harsh Singh¹, Prashant Pratap Singh¹, Yogesh Kumar¹, Satyendra Verma¹, Harish Kumar¹

¹Department of orthopaedics , U P University of Medical sciences Saifai, Etawah , India.

Address of Correspondence:
Dr. Harish Kumar,
Department of Orthopaedics, U P University of Medical Sciences Saifai, Etawah, UttarPradesh, India.
E-mail: drharishkumar01@gmail.com


Abstract:

Introduction: Anterior cruciate ligament (ACL) tears mostly managed with arthroscopic reconstruction with auto tendons grafts. Interference screws are often used to secure the graft in bone tunnels in the tibia. Two types of interference screws are used to secure graft bioabsorbable screws and metallic screws mostly of titanium. Although bioabsrbable screws remain popular due to its bioabsorbabilty but in developing countries like india its cost always pose a difference compare to metallic screws. This study shows functional outcomes of arthroscopic ACL reconstruction with quadrupled hamstring graft fixation with metallic screw on tibial side and metallic endobutton on femoral side on short period of time 1 year
Method: This is a prospective outcome study conducted on 35 patients in the Department of Orthopaedics, UPUMS,
saifai between january 2017 to July 2018 .Patients with Chronic and Acute ACL tear of range 18 to 50 years of age were included in the study. Patients having ACL tear with other comobiditis, fractures, multiligaments injuries were excluded from this study. After proper consent all 35 cases were operated with arthroscopic ACL reconstruction with standard surgical procedure using quadruple hamstring grafts.Titanium metallic screws were used to secure graft on tibial side fixation. In post operative period and rehabilitation period standard protocol was followed. All patients were followed in OPD at every month upto 3 month, after 3 months patients followed every three months upto 1 years.
Results: Results of procedure was calculated using lysholm knee score. Lysholm knee score was signicantly improved
from pre op score, mean 72 to mean 82 at 6 months, at 9 months 89 and finally at one year mean score improved to
mean 93 . All these finding were statistically significant from 6 months and continuously improved significantly at 9 and 12 months. Functional results also improved significantly, at 6 months out of 35 patients, 18 patients (50%) showed good results and 16 patients (48%) showed fair results. At 9 months out of 35 patients 32 patients(90%) were presented with good results, in 3 patient(10.3%) presented fair resultS. At final outcome at 12 month out of 35 patients, 8 patients (29%) showed excellent results while 19 patients (68%) showed good results.
Conclusion: Metallic interference screw fixation on tibial side using hamstring tendon graft is viable option as compared to bioabsorbable interference screw fixation .in indian scenerio choice of procedure due to its cost effectiveness
Keywords: Anterior cruciate ligament (ACL), Hamstring tendon graft, Arthroscopy.


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Published 2017 Mar 18. doi:10.5312/wjo.v8.i3.212
7. Hewett TE, Myer GD, Ford KR, Paterno MV, Quatman CE. Mechanisms, prediction, and prevention of ACL injuries: Cut risk with three sharpened and validated tools. J Orthop Res. 2016;34(11):1843–1855. doi:10.1002/jor.23414
8. Grindem H, Eitzen I, Engebretsen L, Snyder-Mackler L, Risberg MA. Nonsurgical or Surgical Treatment of ACL
Injuries: Knee Function, Sports Participation, and Knee Reinjury: The Delaware-Oslo ACL Cohort Study. J Bone
J o i n t S u r g A m . 2 0 1 4 ; 9 6 ( 1 5 ) : 1 2 3 3 – 1 2 4 1 . doi:10.2106/JBJS.M.01054
9. Monk APaul, Davies LJ, Hopewell S, Harris K, Beard DJ, Price AJ. Surgical versus conservative interventions for treating anterior cruciate ligament injuries. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD011166. DOI: 10.1002/14651858.CD011166.pub2
10) Dhillon M S, Lokesh A V. Bioabsorbable implants in orthopaedics. Indian J Orthop 2006;40:205-9
11) Rocco Papalia, Sebastiano Vasta, Stefano D’Adamio, Antonino Giacalone, Nicola Maffulli, Vincenzo Denaro, Metallic or bioabsorbable interference screw for graft fixation in anterior cruciate ligament (ACL) reconstruction?, British Medical Bulletin, Volume 109, Issue 1, March 2014, Pages 19–29, https://doi.org/10.1093/bmb/ldt038
12) Randy Mascarenhas et al,Bioabsorbable Versus Metallic Interference Screws inAnterior Cruciate Ligament Reconstruction: A SystematicReview of Overlapping Metaanalyse, Arthroscopy: The Journal of Arthroscopic and
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How to Cite this Article: Kumar S, Singh H, Singh PP, Kumar Y, Verma S, Kumar H | Functional outcome of arthroscopic ACL reconstruction with quadrupled hamstring
tendon graft and fixation with metallic screw | Journal of Bone and Joint Diseases | May-Aug 2020;35(2):36-41.
 


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Clinico-Radiological and Functional outome of anterior bridge plating with Minimally Invasive Plate Osteosynthesis (MIPO) in diaphyseal fracture humerus: A prospective study

Vol 35 | Issue 2 | May-Aug 2020 | page: 30-35 | Amit Saraf¹, Vakul Mahipal¹, Najmul Huda¹


Authors: Amit Saraf¹, Vakul Mahipal¹, Najmul Huda¹

¹Department of Orthopaedics, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, India.

Address of Correspondence:
Dr. Najmul Huda
Teerthanker Mahaveer Medical College and Research Centre, Moradabad, India.
E-mail – hudanajamul@gmail.com


Abstract:
Aim: The aim of our work is to assess the clinico-radiological and functional outcome in management of humerus diaphyseal fracture by anterior bridge plating with MIPO technique. METHODS: 21 patients of traumatic diaphyseal fractures of humerus were managed by Anterior Bridge Plating using MIPO technique between 2017- 2018 in a series conducted at our center. The side affected, gender ratio, surgery time, fracture union time and complication were noted. UCLA shoulder and Mayo elbow performance score were used. RESULTS: The study population consisted of 11(52.4%) males and 10(47.6%) females. The mean age was 39.71±13.18 (Range = 18-65) years. Mean surgical time was 99.52 minutes. Road traffic injury was the most common mode. 1 case of infection 2 of non union and 3 cases of post op radial nerve palsy encountered and resolved accordingly. The mean UCLA shoulder and MEPS showed statistically significant improvement in functional outcome with time. CONCLUSION: There is statistically significant improvement in clinic-radiological and functional outcome with time. Anterior Bridge plating with MIPO technique is a good technique which respects the biological fixation principles and causes minimal soft tissue assault while preserving the fracture haematoma and maintains periosteal blood channels for management of humeral diaphyseal fractures.
Keywords: Minimally invasive plate osteosynthesis (MIPO), Diaphyseal fracture humerus, Anterior bridge plating


References

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7. Chao TC, Chou WY, Chung JC, Hsu CJ. Humeral shaft fractures treated by dynamic compression plates, Ender nails and interlocking nails. Int Orthop. 2005;29:88-91.
8. Camden P, Nade S. Fracture bracing of the humerus. Injury. 1992;23:245-8.
9. Baumgaertel F, Buhl M, Rahn BA. Fracture healing in biological plate osteosynthesis. Injury. 1998; 29(Suppl 3):C3‑6.
10. Dickson KF, Munz JW. Locked plating: Biomechanics and biology. Tech Orthop. 2007; 22:4.
11. Wagner M, Frenk A, Frigg R. Locked plating: Biomechanics and biology and locked plating: Clinical indications. Tech Orthop.2007; 22:4.
12. Kulkarni M, Kulkarni V, Kulkarni S. Treatment of Humerus Diaphyseal Fractures with Minimally Invasive Plate Osteosynthesis. J Fract Sprains. 2017;1(1):1007.
13. Walker M, Palumbo B, Badman B, Brooks J, Van Gelderen J, Mighell M. Humeral shaft fractures: a review. J Shoulder Elbow Surg. 2011;20(5):833-44.
14. Sarmiento A, Zagorski JB, Zych GA, Latta LL, Capps CA.Functional bracing for the treatment of fractures of the humeral diaphysis. J Bone Joint Surg Am. 2000;82(4):478-86.
15. Kurup H, Hossain M, Andrew JG. Dynamic compression plating versus locked intramedullary nailing for humeral shaft fractures in adults. Cochrane Database Syst Rev. 2011;(6):CD005959.
16. An Z, Zeng B, He X, Chen Q, Hu S. Plating osteosynthesis of mid-distal humeral shaft fractures: minimally invasive versus conventional open reduction technique. Int Orthop. 2010;34(1):131-5.
17. Kim JW, Oh CW, Byun YS, Kim JJ, Park KC. A prospective randomized study of operative treatment for non comminuted humeral shaft fractures: conventional open plating versus minimal invasive plate osteosynthesis. J Orthop Trauma. 2015;29(4):189-94.
18. Vegad T et al. Follow up assessment of patients with humeral bridge plate technique with two year period Int J Res Orthop. 2017 Jul;3(4):867-870.
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23. Deepak S, Holagundi L, Dayanand, Padmanabha, Murulidharan N. Minimally invasive percutaneous plate osteosynthesis by anterior approach for fracture shaft of Humerus. International Journal of Orthopaedics Sciences 2016;2(3):22-26.
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How to Cite this Article: Saraf A, Mahipal V, Huda N | To analyze the clinical and functional outcome in patients undergoing an arthroscopically assisted ‘mini open repair’ of rotator cuff tear | Journal of Bone and Joint Diseases | May-Aug 2020; 35(2): 30-35 .


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Functional and Radiological Evaluation Of Clavicular Fractures Managed By Elastic Nailing: A Prospective Study

Vol 35 | Issue 2 | May-Aug 2020 | page: 25-29 | Amit Saraf¹, Varun Singh¹, Najmul Huda¹


Authors: Amit Saraf¹, Varun Singh¹, Najmul Huda¹

¹Department of Orthopedics, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, UttarPradesh, India.

Address of Correspondence:
Dr. Najmul Huda,
Department of Orthopedics, Teerthanker Mahaveer Medical College and Research Centre, Moradabad, UttarPradesh, India.
E-mail: hudanajmul@gmail.com


Abstract:

Background: Middle one third fractures of the clavicle bone comprise around 80% of all clavicle fractures. Nonsurgical methods have been practiced for management of clavicle fracture, but with some problems like “non-union”, “mal-union” and shoulders asymmetry.  Two surgical procedures are commonly used to repair displaced mid shaft clavicular fractures internally: plating& intramedullary nailing with titanium elastic nail (TEN). The choice of surgical treatment remains controversial but Intra-medullary nailing of the clavicle has been shown to have considerable benefits over other forms of fixation.
Materials & Methods: This prospective study was performed in Department of Orthopaedics at Teerthankar Mahaveer Medical College and Research Centre, Moradabad for duration of one year on patients with clavicular Fractures who were managed by Elastic Intra-medullary Nailing were enrolled in the research fulfilling, inclusion and exclusion criteria.  The functional ability of shoulder was checked with DASH score for each follow-up. Radiological Assessment was done by checking – signs of Non Union.
Results: Total 22 patients of clavicular fractures managed by elastic nailing. The mean difference DASH Score at different follow up duration with respect to the mean DASH score at 4 weeks and the association was observed as statistically significant (p less than0.05). The final outcome of the studied patients and the majority of patients yielded good result (42.8%) followed by excellent (42.8%) result.
Conclusion: The intra-medullary fixation of clavicle fractures with TENS is a reliable, minimally invasive procedure in specific cases and provides good functional and cosmetic results in our research.
Keywords: Clavicle, Fracture, Intramedullary Nailing, DASH Score


References

1. Masatwar PV, Chishti SN, Singh SN, Maske RG, Soring D, Parija D. A prospective study of operative management of simple midshaft clavicular fracture with titanium elastic nail (TEN). IJOS. 2016;2(4):210-213.
2. Bithrey JW, JF van der Merwe. Outcomes of treatment of displaced midshaft clavicle fractures in adolescents using titanium elastic nails. SAOJ. 2017;16(3):55-61.
3. Mishra P K, Gupta A, Gaur S C. Midshaft Clavicular Fracture and Titanium Elastic Intramedullary Nail. Journal of Clinical and Diagnostic Research. 2014;8(1):129-132.
4. McGraw MA, Mehlman CT, Lindsell CJ, Kirby CL. Postnatal Growth of the Clavicle: Birth to Eighteen Years of Age. J Pediatr Orthop. 2009;29(8):937–943.
5. Edelson JG. The bony anatomy of clavicular malunions. J Shoulder Elbow Surg. 2003;12(2):17-
35.
6. Beigang Fu. Minimally invasive intramedullary nailing of clavicular fractures by a new titanium elastic nail. Acta Orthopaedica et Traumatologica Turcica. 2016;50:494-500.
7. McGraw MA, Mehlman CT, Lindsell CJ, Kirby CL. Postnatal Growth of the Clavicle: Birth to Eighteen Years of Age. J Pediatr Orthop. 2009;29(8):937–943.
8. Shokouh HK, Naderi MN, and Shokouh MK. Treatment of Midshaft Clavicular Fractures with Elastic Titanium Nails. Trauma Mon. 2014;19(3):15623.
9. Kadakia AP, Rambani R, Qamar F, McCoy S, Koch L, and Venkateswaran BC. Titanium elastic stable intramedullary nailing of displaced midshaft clavicle fractures: A review of 38 cases. Int J Shoulder Surg. 2012;6(3):82–85.
10. Kumar H, Banga RK, Boparai RS, Singh J. Flexible Intramedullary Nailing for Fixation of Displaced Midshaft Clavicle Fractures. J Med Sci 2018;38(2):67‑72.
11. Kumar M, Mishra A, Kumar D, Singh A, Pandey D and Sinha AK. A comparative studyof displaced midshaft clavicle fracture managed by precontoured locking compressionplates and titanium elastic nails. International Journal of Orthopaedics Sciences 2018;4(2): 116-121.
12. Hartmann F, Hessmann MH, Gercek E, Rommens PM. Elastic intramedullary nailing of midclavicular fractures. ActaChir Belg. 2008;108(4):428-32.
13. Saha P, Datta P, Ayan S, Garg AK, Bandyopadhyay U, Kundu S. Plate versus titanium elastic nail in treatment of displaced midshaft clavicle fractures: A comparative study. Indian J Orthop. 2014;48(5):87-93.


How to Cite this Article: Saraf A, Singh V, Huda N. Functional and Radiological Evaluation Of Clavicular Fractures Managed By Elastic Nailing: A Prospective Study.
Journal of Bone and Joint Diseases May-Aug 2020;35(2): 25-29.


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Comparative study between hybrid fixation and dual plating in the management of both bone forearm fractures involving proximal half of radial shaft in adult patients

Vol 35 | Issue 2 | May-Aug 2020 | page: 19-24 | Arvind Kumar¹, Rizwan Khan¹, Dushyant Chouhan², Rajesh Arora¹, Sandeep Kumar¹, Javed Jameel¹


Authors: Arvind Kumar¹, Rizwan Khan¹, Dushyant Chouhan², Rajesh Arora¹, Sandeep Kumar¹, Javed Jameel¹

¹Department of Orthopedics, Hamdard Institute of Medical Sciences and Research,
New Delhi, India.
²Department of Orthopedics, Lady Hardinge Medical College, New Delhi, India

Address of Correspondence:
Dr. Javed Jameel,
Hamdard Institute of Medical Sciences and Research, New Delhi, India
E-mail: javedjameel@gmail.com


Abstract
Background: Both bone forearm fractures in adults are conventionally managed with plate fixation for both radius and ulna. The fractures involving proximal half of radial shaft need extensive muscle dissection, periosteal stripping and carry a risk of posterior interosseous nerve injury. Hybrid fixation for such fractures with titanium elastic nail system (TENs) for radial fixation and standard plating for ulnar fracture is a potentially safer alternative for these fractures. The purpose of this study is to compare the outcomes of the aforementioned hybrid fixation to conventional dual plating for adult both bone forearm fractures involving proximal half of the radial shaft.
Methods: Adult patients with both bone forearm fractures involving proximal half of the radial shaft were randomly divided into a hybrid fixation(A) and dual plating(B) groups over a two-year period. The patients were followed for a minimum of six months and radiological and functional outcomes were compared.
Results: Radiological and functional outcomes between the two groups were comparable with the exception of wrist dorsiflexion which was significantly reduced in the hybrid fixation group. The surgical duration was significantly shorter in hybrid fixation group. Loss of reduction and nail entry point pain were major complications in the hybrid fixation group. Hypertrophic radial scar and transient posterior interosseous nerve palsy were major complications in the dual plating group.
Conclusion: Hybrid fixation using plate osteosynthesis for ulnar fracture and TENs for radial fracture is a valid option for treatment of adult both bone forearm fractures involving the proximal half of radial shaft with a shorter surgical duration and less soft tissue complications when compared to open reduction and plate osteosynthesis for both the fractures.
Keywords: Adult; forearm, Fractures, Hybrid fixation, Proximal radius


References

1. Charles M. Court Brown, Stuart A. Aitken, Daren Forward, V. Robert, O’Toole III The epidemiology of fractures. In: Charles A. Rockwood, David P. Green, Robert W. Bucholz, editors. Rockwood and Green’s Fractures in Adults (seventh ed.), Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia;2010. pp. 53-84
2. Schulte LM, Meals CG, Neviaser RJ. Management of adult diaphyseal both-bone forearm fractures. J Am AcadOrthopSurg 2014;22(7):437-46.
3. Shah AS, Lesniak BP, Wolter TD, Caird MS, Farley FA, Vander Have KL. Stabilization of adolescent both-bone
forearm fractures: a comparison of intramedullary nailing versus open reduction and internal fixation. J Orthop Trauma 2010;24(7):440-7.
4. Moss JP, Bynum DK. Diaphyseal fractures of the radius and ulna in adults. Hand Clin 2007;23(2):143-51.
5. Tak R, Joshi S. Outcome analysis of hybrid fixation technique (radius nailing and ulna plating) in closed proximal radius and ulna fractures in adults. International Journal of Orthopaedics Sciences 2018;4(1)
6. Kang CN, Kim JH, Kim DW, et al. The operative treatment of the shaft fractures of the forearm bone: operative comparison in intramedullary fixation to plate fixation on treatment of the both forearm bone fracture. J Korean Soc Fract 1998;11(1):63–9.
7. Kim SB, Heo YM, Yi JW, Lee JB, Lim BG. Shaft Fractures of Both Forearm Bones: The Outcomes of Surgical Treatment with Plating Only and Combined Plating and Intramedullary Nailing. Clin Orthop Surg. 2015;7(3):282–90.
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proximal forearm – a patient normalized parameter. World J Orthop 2017;8(4):310–6.
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1986;68:669–674.
13. Cai L, Wang J, Du S, et al. Comparison of Hybrid Fixation to Dual Plating for Both-Bone Forearm Fractures in Older Children. Am J Ther 2016;23(6):1391-6.
14. Zhu S, Yang D, Gong C, Chen C, Chen L. A novel hybrid fixation versus dual plating for both-bone forearm fractures in older children: A prospective comparative study. Int J Surg2019;70:19-24.
15. Dave MB, Parmar KD, Sachde BA. The Radial Bow following Square Nailing in Radius and Ulna Shaft Fractures in Adults and its Relation to Disability and Function. Malays Orthop J 2016;10(2):11–5.
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forearm. J sci society 2014;41(3):167-72.
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18. Sandmann G, Crönlein M, Neumaier M, et al. Reduction and stabilization of radial neck fractures by intramedullary pinning: a technique not only for children. Eur J Med Res 2016;21:15.


How to Cite this Article:  Kumar A, Khan R, Chouhan D, Arora R, Kumar S, Jameel J | Comparative study between hybrid fixation and dual plating in the management of both bone forearm fractures involving proximal half of radial shaft in adult patients. | Journal of Bone and Joint Diseases | May-Aug 2020;35(2):19-24.


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Measurement of posterior tibial slope in north Indian population in relation to squatting

Vol 35 | Issue 2 | May-Aug 2020 | page: 14-18 | Khalid Ahmad Qidwai¹, Shakeel Ahmad Qidwai²


Authors: Khalid Ahmad Qidwai¹, Shakeel Ahmad Qidwai²

¹King George Medical University, Lucknow, UttarPradesh,India.
²Department of Orthopedics Surgery, Era’s University, Lucknow, UttarPradesh,India.

Address of Correspondence:
Dr. Khalid Ahmad Qidwai,
King George Medical University, Lucknow, UttarPradesh,India.
E-mail: khalid.99.q@gmail.com


Abstract:

Background: Tibial plateau, proximal tibial surface, has a slope directed postero-inferiorly relative to the long axis of the middle of the shaft. It has important consideration in surgeries such as knee arthroplasty, high tibial osteotomy, and medical imaging of the knee joint [1]. The aim of the present study was to estimate the Posterior Tibial Slope (PTS) by plain radiograph in the adult Northern Indian population with respect to lifestyle depending upon the squatting habit. It has significance in antero-posterior stability of the knee joint [2]. The current study aims to measure the Posterior Tibial slope in North Indian people and compare the PTS among the groups of people who squat and who do not squat in their day to day activities and draw a conclusion if it has a clinical significance in range of flexion of knee joint in knee arthroplasty.
Material and Method: this study was conducted at the Department of Anatomy, King George Medical University, Lucknow in collaboration with Department of Orthopaedics, Era University Lucknow. Measurements were taken in 37 patients on X-rays with a mean age of 46.5 years. Of the total subjects, 22 were squatters and 15 are non-squatters. Total of 70 X-rays (Knee Joint-Lateral View) were taken in which 43 X-rays were of squatters and 27 X-rays were of non-squatters with 34 X-Rays of left Side and 36 X-rays of right side. (Master Chart enclosed). Reference line taken to measure PTS was Posterior Tibial Cortex (PTC). A line was drawn tangential to PTC. Another line was drawn perpendicular to the first line passing through the anterior most point of the tibial slope. Then a line was drawn tangential to the tibial slope and the PTS was then measured by a protractor.
Results: PTS of non-squa_ers came out to be 9.25°±2.99 while those of squatters 11.67°±2.82. Average PTS was 10.74°±3.1° with 10.08°±3.28 in the left knee and 11.36°±2.83 in the right knee.
Conclusion: The present study described the variation of PTS in north Indian population (Uttar Pradesh) which came out to be 10.74°±3.1°. The PTS of squatters was 11.6°±2.82° and that of non-squatters 9.25°±2.99°. This difference in values of PTS is statistically significant (P=0.0011). Poor or no correlation of PTS was found with age and sex. The difference in PTS values in left and right knee was found to be statistically insignificant (P=0.0844). It may be concluded that in this pilot study squatting has been found to be significant as a cause of increased PTS which may be considered as an indicator for designing TKA implants which accommodate the increased PTS to increase range of flexion. However, authors do recommend MRI/CT Scan based prospective studies on measurement of preoperative PTS and its significance on maximal angle of flexion in post TKA knee joints.
Keywords: Tibial slope, Squatting, Knee arthroplasty.


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16. Seo JG, Moon YW, Kim JH. Influence of posterior tibial slope on stability after total knee arthroplasty. J Korean Knee Soc. 2007;19(2):218–24.
17. Kim KH, Bin SI, Kim JM. The Correlation between Posterior Tibial Slope and Maximal Angle of Flexion after Total Knee Arthroplasty. Knee Surg Relat Res. 2012;24(3):158–163. doi:10.5792/ksrr.2012.24.3.158
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measurement of the tibial slope. A study of 83 healthy knees. Rev Chir Orthop Reparatrice Appar Mot 1996;82:195-200
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How to Cite this Article: Qidwai KA, Qidwai SA | Measurement of posterior tibial slope in north Indian population in relation to squatting | Journal of Bone and Joint
Diseases | May-Aug 2020;35(2):14-18.


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Outcomes of Ponseti technique in management of idiopathic clubfoot in Infants – A short term study of Ninety feet in rural India

Vol 35 | Issue 2 | May-Aug 2020 | page: 9-13 | Sunil Kumar¹, Prashant Pratap Singh¹, Mohit Kumar Singh¹, Yogesh Kumar¹, Satyendra Verma¹, Harish Kumar¹


Authors: Sunil Kumar¹, Prashant Pratap Singh¹, Mohit Kumar Singh¹, Yogesh Kumar¹, Satyendra Verma¹, Harish Kumar¹

¹Department of Orthopaedics, U P University of Medical Sciences Saifai, Etawah, UttarPradesh, India.

Address of Correspondence:
Dr. Harish Kumar,
U P University of Medical Sciences Saifai, Etawah, UttarPradesh, India.
E-mail: drharishkumar01@gmail.com


Abstract

Introduction: CTEV is one of most common deformity of foot and ankle, having incidence of 1 per 1000 childbirth. Male children are more commonly affected; male:female ratio 2:1 and bilateral foot involvements is in 50% of cases. It is accepted globally that first treatment for infants must be non operative irrespective of severity of deformity. The Ponseti method is the most popular and accepted worldwide for clubfoot, with excellent long-term outcome. The present study was carried out to analyse and the outcome of management of idiopathic clubfoot in infants using the Ponseti method in rural Indian population using pirani severity score.
Method: prospective interventional study was conducted from January 2017 to December 2018. Total no of patients included in study were 62 with 90 clubfeet. Infants with unilateral or bilateral clubfoot. Deformity was graded on Pirani severity score for hind foot, mid foot and total foot score. Manipulation and above knee casting were done as an OPD procedure and cases were followed for serial casting in the OPD weekly until desired correction was achieved. On each visit, observations were recorded on the Pirani severity score chart. In all patients, serial casting after manipulation was done according to ponseti technique as described. Percutaneous achilles tendon tenotomy was done if required. Final obseravtions were recorded when all deformities corrected and patient shifted to brace treatment from castings.
Results: The total Mean Pirani score at the time of presentation was 4.6 in 90 feet. At the time of final evaluation total mean Pirani score decreased to 0.55 ,that was statistically significant. At the final outcome, a total of 10 patients and 15 feet showed excellent results(pirani score: 0). 33 patients and 48 feet showed good results (score> 0 to 0.5). Only in 1 case presented a poor outcome (score >1). Fair results were observed in 11 patients and16 feet. Total 43 patients showed excellent to good results (78.18%) and poor results came in only 1 patient.
Conclusion: Ponseti technique, non invasive serial casting with per cutaneous tenotomy in management of idiopathic clubfoot inbinfants is highly successful, very cost effective with very less complications. In Indian rural areas it is very acceptable and satisfactory to patients
Keywords: Idiopathic clubfoot, Ponsati technique, Pirani score, Steenbeek brace


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How to Cite this Article: Kumar S, Singh PP, Singh MK, Kumar Y, Verma S, Kumar H | Outcomes of Ponseti technique in management of idiopathic clubfoot in Infants- A short term study of ninety feet in rural India | Journal of Bone and Joint Diseases| May-Aug 2020;35(2): 9-13.


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