Indian Journal of Orthopaedics Surgery

211-214

Authors: Mukesh Tiwari, Vikram Khanna, Gaurav Maddhesia, Ishan Ghuse

Introduction: Painful shoulder syndrome is also called periarthritis humeroscapularis or PHS syndrome. The shoulder is the most mobile joint, pain and reduced function may be seen because of different inflammatory and degenerative changes in soft tissues of the shoulder. It is most common musculoskeletal disorder after low back pain and cervical pain. Many approaches have been used in the treatment of periarthritis shoulder pain, including local heat, cryotherapy, transcutaneous eletrical nerve stimulation (TENS), short wave therapy (SWD), manipulation under anaethesia, acupuncture and exercise. The purpose of this study is to compare the effectiveness of TENS and SWD in decrease pain and improvement in function in Periarthritis shoulder. Methodology: A total of 40 patients coming in the year 2014 to the outpatient department with a confirmed diagnosis of periarthritis shoulder were included in this study. Two groups of 20 patients each were made. Group A: received SWD and Exercise therapy, whereas Group B received TENS and exercise therapy. Both the group of patients were assessed using the VAS scoring for pain and the Likert’s scale for the functional outcome. Result: Pain improved significantly in both the groups with more pain relief seen in group B as compared to group A. The functionality which was calculated using the Likert’s scale showed significant improvement in both the groups with slightly more increase in the functionality in group A as compared to group B. Discussion: The long term benefits are better achieved with the SWD as compared to the TENS whereas immediate pain relief is achieved with TENS much better than the SWD. Though this cannot be confirmed as firstly the sample size is very small and also a longer follow up may be required to assess long term functional outcome of both the treatment modalities. Conclusion: This study concludes by accepting the alternate hypothesis that is application of TENS treatment along with exercise therapy will improve function and pain relief as compared to SWD therapy. Whereas long term functional result is better with SWD.

221-225

Authors: Vinay N, Rahul Kumar.

Introduction: There is no consensual agreement on the strict clinical or radiographic criteria for defining a flatfoot. Traditionally, a flatfoot has been defined subjectively as a weight-bearing foot with an abnormally low or absent longitudinal arch. This definition is based solely upon the static anatomic comparison of the height of the arch within a population. It fails to take into consideration the etiology of the flatfoot, the functional relationships between the bones, and the presence or evidence-based expectation of future pain or disability. Methodology: All patients in the study were evaluated thoroughly using detailed history and complete physical examination with special emphasis on weight, family history, findings like tight tendoachilles, ligamentous laxity, intermalleolar distance and gait analysis. The examination included biomechanical examination of hip, knee, foot and ankle. Associated conditions were also given importance to rule out any syndromic flat foot. Results: The younger the age group the better they respond to orthotic treatment. More severe the deformity the better they respond to orthotic treatment. Symptomatic fff have better results than asymptomatic fff. Early the orthotic treatment received better is the result. Arch support helps in relieving clinical features like pain and out toeing. Conclusion: Arch index may help in improvement of radiographical angles like cp, tca and tma. There is no short term and long term complications related to using of arch support.

231-235

Authors: Sriram Thanigai T, Deviprasad S, Sathik Babu M B, Pradeep E

Introduction: Ligamentous injuries of the ankle are very commonly encountered in orthopaedic practice and 40% of these injuries constitute the Anterior Talo-Fibuar ligament (ATFL) injuries. It is the weakest of the lateral ligaments. Unless there is significant joint instability, surgery is rarely indicated in the treatment of isolated ATFL injuries. Our study focused on the assessment of the long term outcome of isolated ATFL injuries treated by conservatively. Material and Methods: We included 20 patients who presented to us with isolated ATFL injury from January 2015 to march 2015 for this prospective study. The diagnosis was confirmed with an MRI. 12(60%) patients were grade II and 8 (40%) patients were grade III. All the patients were conservatively treated with the POLICE protocol and weight-bearing was advised as tolerated but strictly with a proper ankle support. Patients were followed up at the end of 1st week, 2nd week, 1 month,3rd month and at 6 months. Patients were evaluated with a Visual Analog Scale (VAS) and the Foot and Ankle Outcome score (FAOS). Results: There was statistically significant improvement in the VAS and FAOS scores. From the pre-treatment scores of 9.1 and 53, they improved to 1.4 and 91 respectively at the final follow-up. Conclusion: From our prospective study, we conclude that conservative management of isolated ATFL injuries is a safe and effective method of treatment.

241-250

Authors: Satyendra Phuljhele, Rajendra Kumar Ahire, Harshal Sakale

Introduction: This paper determines if Osteosynthesis or Prosthesis replacement should be the treatment of choice, in active elderly patient with unstable intracapsular neck femur fracture. Material and Methods: A prospective analysis of the results of 46 patients that were performed in Pt. J.N.M. Medical College and associated Dr. B.R.A.M. Hospital Raipur (C.G.) over a period of 2 year was undertaken. The minimum period of follow-up was 2 years. Results: Out of these 46, 31 patients were treated with internal fixation (Richard’s compressive hip screw with supplementary cancellous screw fixation) and 15 patients were treated with Hemiarthroplasty (Austin Moore Unipolar Endoprosthesis). Overall, the average age of patients was 62.5 years. The mean age for internal fixation was 59 years and that of Hemiarthroplasty was 66 years. 61% of the patients were between 55-65 years of age group. Overall 29 patient (63%) were male and 17 patient were female (37%).Union occurred in 89% of cases in internal fixation. Overall, the functional outcome in internal fixation group was satisfactory with excellent/ good result found in 78% of cases, while in Hemiarthroplasty group it was 63%. Osteosynthesis group has less complication rate like pain, infection, fracture of shaft of femur, shortening and mortality than Hemiarthroplasty group. Conclusion: Osteosynthesis is justified as a primary treatment of intracapsular hip fracture even in displaced type in active elderly patient aged 55-65 years. Prosthesis replacement should be used in cases where neck is absorbed, in failed Osteosynthesis and in Non-union.

255-260

Authors: Choudhari Pradeep, Agrawal Anuj, Gurjar Abhishek

Introduction: Unstable intertrochanteric fractures in osteoporotic bones are difficult to treat. Conservative treatment with traction and prolonged immobilization lands up with many complications and often fatality. Rate of failure in internal fixation, with dynamic hip screws or intramedullary nail has been found high, especially in osteoporotic bones. The weak and porotic bone tolerates screws poorly so cut out is the major problem in internal fixation. The aim of this study was to assess the efficacy of cemented hemiarthroplasty in the management of proximal femoral fractures in elderly patients with severe osteoporosis. Material and Methods: 25 patients (11 males and 14 females) above 65 years of age with unstable intertrochanteric fractures who underwent bipolar arthroplasty were prospectively evaluated. Transtrochanteric approach was used in all patients. Greater trochanter encirclage was done in all patients. Harris hip score was used for the clinical evaluation. The minimum follow up period was one year. Results: In our study 25 cases were taken, which had a mean age 73.44 ± 7.11years. The mean Harris hip score at one year was 80.54 ± 19.74. Excellent to good results were obtained at one year in 17(68%) cases and fair in 4 (16%) cases, poor in 2 (8%). Death of two patients occurs due to age related factors. Mean hospital stay was 14.24 ± 10.46 days. There was one case of superficial infection and one case of dislocation which where managed conservatively. Mean hospital stay was 14.24 ± 10.46. Radiological follow-up showed no case with loosening of the prosthesis, break in the cement or sinking of the prosthesis. Conclusion: Cemented bipolar hemiarthroplasty through trans-trochanteric approach give good result in a majority of elderly patient with unstable intertrochanteric fracture. It has advantage of an early ambulation and less hospital stay, as compared to the internal fixation. Also, the patient rehabilitation is easy and fast and none of the patient required any revision surgery. But the follow up period in our study is not enough to make any clinical recommendations though it can serve as a critical analysis to stimulate future research. Further long term studies are required.

265-272

Authors: SPS Gill, Dinesh Kumar, Manish Raj, Pulkesh Singh, Jasveer Singh, Rakesh Vishwakarma

Introduction: Femoral neck fracture at any age always shows relatively higher rate of complications like non union, avascular Necrosis of femoral head, loss of fixation, screw cut-out and delayed secondary osteoarthritis. These fractures in physiologically old age are managed by replacement of femoral head. In Femoral neck fractures in young adult the main aim is to preserve the natural head and these cases are managed by Multiple cancellous screw, CanulatedCancellous Screw(CCS) with fibular graft either free fibular or vascularised fibular graft. Replacement surgeries in these cases are a difficult choice as young age and also high cost of implants. Also in these patients it is difficult to restrict squatting for lifelong due to social culture and lack of toilets. Now days also preferences are given to head sparing surgeries and osteosynthesis. We use primary double angle barrel plate with intertrochanteric valgus osteotomy for the management of femoral neck fracture in young adults. Material and method: Cases were selected from the patients attending in Orthopaedics OPD and emergency trauma centre of UPRIMS & R, Saifai, Etawah from May 2006 to August 2013. During this period total 44 cases of fracture neck femur were selected for primary fixation with dauble Angle Barrel Plate (DABP). Out of 44 cases 30 were female and 14 were male with age range from 18 yrs to 48 yrs and average age of 42 yrs. Average duration from injury to operative procedure was 1.3 weeks (10 Days) and range from 2 days to 15 weeks. These cases were operated by Double angle barrel plate with intertrochanteric valgus osteotomy and long term result evaluated using Modified Askin and Bryan criteria. Result: Out of 44 cases operated 42 cases followed up to the average duration of 48 months and all these 42 cases show good(18) to Excellent(20) results after 4 yrs according to Harris hip score. 4 cases shows fair result and other secondary procedure were required in these cases. Complication seen during follow up were avascular necrosis in 7 cases and out of these 7, 4 cases given poor result as these were also shown loosening of fixation and crew cut out. Out of 42 cases 38 cases were able to perform squatting after 4 yrs of follow up and also there were no radiological sign AVN of head at all. Loss of reduction and screw cut out seen in two cases and these were in poor outcome group. Discussion: Fracture neck femurs are not rare presentation in developing countries. Various modalities of treatment are fibular graft, ileac bone graft, multiple screws with fibular graft, muscle pedicle graft. We in our series done primary osteotomy combined with double angle barrel plate (DABP) achieved excellent to good results in 90% cases. Primary osteotomy with double angle barrel plate is a good alternative for the management of femoral neck fracture in young patients.

279-281

Authors: Prasad Soraganvi, Anand Kumar BS, Gadiyar HB, Satyarup Dasanna

Background and objective: Anterior cruciate ligament (ACL) rupture is the most common among young population involved in sports activates. In previous literature it is evident that delay in reconstruction results in increased incidence of meniscal injury and degenerative changes due to knee instability. The aim of this study is to find out incidence of meniscal injury and cartilage damage in ACL deficient knee and weather the incidence is more in chronic ACL deficient knee. Methods: All cases of ACL reconstruction done in our institution during 2011 to 2015 were included in study. Patients above 50 years were excluded. The case records reviewed and data collected. The time period between primary injury and surgery noted along with findings in diagnostic arthroscopy. The cases were divided as per the times when surgery was done after primary injury in to two groups as early reconstruction group (Group A) and late reconstruction group (Group B). The associated injuries of meniscus and cartilage damage were noted in both groups. Results: After considering inclusion and exclusion criteria 113 patient were included in study. 65 patients were in Group A and 48 patients in Group B. 36 patients (74%) in Group B and 23 patients (25%) in Group had meniscal injury. It was observed that Group B had high incidence of medial meniscal injury compared to Group A. four patients in Group B had chondral damage compared to one patient in Group A. Conclusion: Incidence of medial meniscus injury and both meniscus injury was found to be more in late reconstruction group. Chondral damage also is more in late reconstruction group. Delay in ACL reconstruction results in early onset of degenerative changes and meniscal injury. We recommend early reconstruction of ACL preferably within three months.

286-290

Authors: Prashant Upadhyaya, Jayant Sharma

We present a study of open arthrolysis of the elbow for Elbow stiffness due to an unusual aetiology. The range of movement of the elbow, pain scores and functional outcomes were recorded pre- and postoperatively. An improvement in the mean range of movement from 70° (0° to 95°) to 110°(55° to 135°) was obtained in our patients at one year. On the basis of this study, we believe that the results of open arthrolysis for posttraumatic stiffness of the elbow are durable over the medium term.