Indian Journal of Orthopaedics Surgery

1-3

Authors: Druvan Shaji,Anubhav Sharma*,Thadi Mohan

Introduction: It has been proposed that a narrow intercondylar notch may increase the risk of anterior cruciate ligament (ACL) injury but the data are conflicting. We performed this cross-sectional study to investigate the significance of Notch width index for ACL tears. Materials and Methods: All adult patients with knee problems, who were referred to the Department of Orthopaedics Amrita Institute of Medical Sciences, Kochi and underwent MRI knee, from August 2016 to August 2018, were included in this study. Axial and longitudinal MRI was performed using 1.5 Tesla or 3 Tesla MRI with the patient's knee in an extended position. In all patients, the femoral notch Index was measured. Patient were divided into 2 groups depending on their NWI (<0>0.2) Because of the effect of osteoarthritis in decreasing the intercondylar notch index, cases with obvious osteoarthritis were not included in the study. To test the statistical significance of the difference in Femoral Notch Width Index with respect to gender Student’s t test was used. To test the statistical significance of difference in percentage’s with respect to ACL tear (yes or no) and Femoral Notch Width Index(<0>0.2) Chi-square test was used. Results: 300 patients were enrolled in the study. The age range was 20-50 years. We found that group 1 (<0>0.2 NWI). We also found that male’s have a higher NWI as compared to females (p value <0> Conclusion: ACL tear was found to be higher among the patients with NWI < 0>0.2 which is statistically significant.

10-14

Authors: Eeshan Bhardwaj*,F Abdul Khader

Introduction: Clavicle is the bone which links thorax to the shoulder and help in movements at shoulder joints. It is the first long bone to ossify in the body. Clavicle fractures are the most common fractures in the upper limb. The purpose of this study is to measure the functional outcome of mid third displaced clavicular fractures treated by open reduction and internal fixation with plate osteosynthesis and conservative management. |Materials and Methods: This study was done in Tertiary Institute, Ammapettai, in between May 2017 – September 2018, Ethical committee approval obtained, IHEC No: 2017/312.Patients were allocated in two groups and were given treatment as per the group. 20 cases were treated conservatively and 20 with plate osteosynthesis. Patients were followed every 3rd, 6th, 9th month. Result: The mean union rate in our study was 10 weeks and constant shoulder score was 90 for conservative group. 20 patients in plate Osteo-synthesis the average union was 6wks and constant shoulder score was about 95 with an excellent grade. Conclusion: Plate osteosynthesis in displaced midshaft clavicle fracture has resulted in excellent functional outcomes and also good union rate.

21-28

Authors: Vikramjit Singh,Anirudh Bansal,Arvind Kumar*,Sudhir Rawat,Bhagirat Sinh Kela

Introduction: Lumbar spinal stenosis is a frequent indication for spinal surgery. The clinical symptoms may not be accurately reflected on radiological studies. Treatment is aimed at not only obtaining immediate pain relief but also in preventing its long?term disabling sequelae. The walking ability needs to be correlated with functional outcome measures in assessing patients with symptomatic lumbar canal stenosis (LCS). Aims and Objectives: To study and evaluate the outcome of surgery for degenerative LCS on a clinical, radiological, and functional basis, and to establish an association between various factors that may be influencing the development of LCS. Materials and Methods: A prospective study of 24 patients was carried out at the Department of Orthopaedics, Dhiraj General Hospital, Piparia, Vadodara, in whom the LCS was confirmed and measured on magnetic resonance imaging images by thecal sac cross?sectional area (CSA). The functional assessment pre-operative and post-operatively was calculated according to the Japanese Orthopaedic association score. Results: Overall, 83.33% patients (n=20) in our study showed improvement in all variables of the JOA scoring system postoperatively. 66.66% patients (n=16) showed excellent outcome, 25% (n=6) showed good outcome, and 8.33% (n=2) showed fair outcome. No patient had poor outcome. After surgery 95.83% patients (n=23) had normal gait with walking distance more than 500 m and no claudication symptoms. Conclusions: Operative treatment in patients of degenerative lumbar canal stenosis with decompression and spinal instrumentation yields excellent results as observed on the basis of JOA scoring system

35-41

Authors: Ravindra Patil,Sowen Modi*,Sreeharsha Rajoli,Ratish Kumar,Gunjan Ghelani

Introduction: Subtrochanteric typically defined as area from lesser trochanter to 5cm distal. Treating a subtrochanteric fractures is associated with difficulties due to anatomical and biomechanical factors comprising mainly due to poor reduction, varus deformity, non union, poor bone quality, comorbidities. Encerclage wire helps in reduction but its use remains controversial due to disturbance of blood supply to the underlying bone and soft tissue damage. This study was undertaken to study the use of encerclage wire for fracture reduction and associated complications. Materials and Methods: Retrospective analysis of patients of age group 20 years and above having subtrochanteric femur fracture, admitted and treated with Long PFN between June 2016 and Sept 2018 were considered in this study. After exclusion 34 patients with an average follow up of 16.8 months were included in this study. Indications for encerclage were fracture patterns like long oblique, spiral, spiral wedge or comminuted fracture with butterfly fragment. Cerclage wire was employed in 15 patients and wire passed through cerclage wire passer. Assessment was done in terms of operation time, quality of reduction, neck shaft angle, union time, complications and final functional outcome by Harris Hip Score. Result: Average operation time and blood loss was significantly higher in cerclage group as compared to without encerclage (p =0.042), anatomical reduction was achieved by in 93% in encerclage group as compared to 79% in non encerclage group. Postoperative Neck shaft angle was 132.80 versus 132.10. Mean Union rate was 14.3 weeks versus 15.6 weeks. 3 patient in non encerclage developed non-union of which 2 patients had nail breakage superficial wound infection was seen in 1 patient in encerclage group and was resolved with regular dressing. Mean range of hip flexion was 123.6o and extension was 14.8o. Conclusion: Encerclage wire gives a better outcome for fracture reduction, decreases varus deformity, and overall there are no major complications. It is although associated with increased operation time and blood loss.

46-51

Authors: S Aathithya*,Mohan B Chowdhary

Introduction: Globally about 70% of the hip fractures are due to the neck of femur fracture. Surgical management has proved to be clinically and functionally superior to conservative immobilization. Hence the study is to assess the optimal treatment modality for the treatment of neck of femur fractures. Materials and Methods: The present study is an analytical cross-sectional study. About 70 patients diagnosed with unstable neck of femur fractures who were treated with total hip replacement as 35 cases (Group 1) and bipolar hemiarthroplasty as 35 cases (Group 2). The study duration was from April 2016 to September 2018. Results: The female population was also found to be more prone for fractures in both -THR group (65%) and bipolar hemiarthroplasty group (60%). The mean duration of stay in the hospital is lower in the THR group (6 days) when compared with the bipolar hemiarthroplasty group (8 days). The mean time till full weight bearing walking (days) was observed to be significantly reduced in the THR group (2.73 days) when compared with the bipolar hemiarthroplasty group (3 days). The mean mortality rate in the THR group (3.3%) was observed to be lower than the bipolar hemiarthroplasty group (5.5%). Conclusion: Total hip replacement, however is observed to be superior to bipolar hemiarthroplasty in terms of duration of hospital stay, immediate full-weight bearing walking and better functional outcomes with fewer complications.

57-65

Authors: Madhuchandra P,Sunil Santhosh G*,Raju K.P,Pawankumar KM,Nandeesh S

Introduction: Incidence of fractures around the hip is increasing worldwide owing to increased life span of the people and secondary to osteoporotic fragile bones. Stable intertrochanteric fractures can be easily treated by internal fixation methods. Unstable comminuted and osteoporotic idsntertrochanteric fractures are very difficult to treat. They can be treated by internal fixation with proximal femoral nail. But chances of implant failure and non union are high with highly osteoporotic and comminuted fractures. In such cases primary hemiarthroplasty is an useful alternative option. We have compared the outcomes of unstable intertrochanteric fractures treated with hemiarthroplasty and proximal femoral nail. Materials and Methods: Our study was conducted in BGS Global Institute of Medical Sciences, Bangalore from January 2014 to December 2016 on patients who had sustained intertrochanteric fractures. It was a prospective study done for a period of two years. Patients with intertrochanteric fractures who had come to our hospital were included in our study. Patients aged more than 60 years with closed intertrochanteric fractures were included in the study. Patients were divided as group I- operated with hemiarthroplasty and group II- operated with proximal femoral nail. Functional outcome of both groups was assessed using Harris Hip scale and various parameters were compared. Results: Majority of the patients were in the age group 70-79 years, 16 being females and 14 males. Commonest mode of injury was trivial fall (83.33%). Average duration of hospital stay for hemi-arthroplasty patients was 14.33 days and for PFN patients was 11.86 days.15 patients had associated conditions like diabetes or hypertension. Average intra-operative blood loss was 516.66 ml for hemi-arthroplsty and 187.33 ml for PFN. Average operating time for hemi-arthroplasy was 80 minutes whereas for PFN was 83.33 minutes. Mean harris hip score at the end of one year for hemi-arthroplasty was 76.46 and for PFN was 77.8. Conclusion: The outcomes of both the modalities are almost equal. PFN has an advantage of shorter operative time, less blood loss, lower hospital stay with no difference in functional outcome or general complications as compared to hemiarthroplasty. Major advantage of PFN is patients treated with PFN can squat and sit cross legged after fracture union. Hemiarthroplasty does provide a stable, pain-free, and mobile joint with a very low complication rate as seen in our study; however a larger prospective randomized study with longer follow up comparing the use of PFN against primary hemi-arthroplasty for proximal femur fractures needs to be done

72-82

Authors: R Sahaya Jose*

Introduction and Objectives: The Aim of this study is to evaluate the Short Term Functional Outcome of Unipolar and Bipolar hemiarthroplasty in Intracapsular neck of femur fracture. Materials and Methods: 40 patients with Intracapsular fracture neck of femur were included in this study. 20 patients were treated with unipolar hemiarthroplasty and 20 patients with bipolar hemiarthroplasty, respectively. In both the groups, patients were evaluated for functional outcome by using Harris hip score. The Data was analysed by SPSS 20.00 using Chi-square test. Results: Our overall mean Harris hip score pre operatively for unipolar hemiarthroplasty was 36.2 and bipolar hemiarthroplasty was 39.1 which increased to 81.8 for unipolar and 85.05 for bipolar hemiarthroplasty respectively, with p-value of <0> Conclusion: The results of our study shows that uncemented bipolar hemiarthroplasty gave better results when compared with uncemented unipolar hemiartheoplasty. Our results also shows that, cemented bipolar hemiarthroplasty gave better results when compared with cemented unipolar hemiarthroplasty clinically. Thus, Bipolar hemiarthroplasty did better when compared with unipolar hemiarthroplasty in general.

88-94

Authors: Varun Khanna*,Rakesh Sharma

Introduction: For decades, knee OA had been viewed as a disease mostly affecting older population, consequently, only few population-based studies have examined the frequency and characteristics of OA knee in persons under the age of 40 years leading to dearth of literature over this subject matter. Recent evidence however, documents increased incidence of two key risk factors for knee OA – traumatic knee injury and obesity, particularly in the young. Studies have shown that mean age of onset of osteoarthritis knee has decreased over couple of decades and projected incidence of the disease in young is on the rise. Materials and Methods: Patients of either sex coming to the OPD of the Department of Orthopaedics with chief complaint of knee pain were assessed as per the preformed and pretested questionnaire and subjected to AP view of both knee in standing position until 200 such cases with age ? 40yrs were separated. The cases were assessed as per Kellgren Lawrence grading. The patients were also assessed for height, weight, BMI and other parameters. Cases were selected carefully after excluding the subjects as per the adopted exclusion criterion. Results: After survey of 200 knee pain patients below 40 years of age, over a period of one and a half years, incidence of primary osteoarthritis knee on the radiological basis was found to be 6.54%. Mean age of 200 subjects were 34.7 years with female: male ratio being 6:1(p=0.004). 82.1% cases of OA had BMI >24.9kg/m2 (p=0.004) whereas 80 females cases had BMI>24.9kg/m2 (p=0.007). 53.5% cases had predominantly sitting/ squatting /kneeling as household habits (p=0.02). 67.8% cases were of medium activity group on the basis of their occupation while 57.1% (p=0.05) of cases had history of OA knees in the first degree relatives. Conclusion: The incidence of OA knee in the young is increasing. Knowing the risk factors and disease volume in younger age groups would allow primary prevention of OA to be implemented in young adulthood to curtail the emergence of radiographically-defined OA at the mid-life and also prevent disabilities saving the healthcare system from the tremendous economic burden of the disease.

99-100

Authors: Ashok Goel,Mridul Maheshwari,Mohammed Saif Niyazi*,Alok Gupta

An End cap for an Intra- medullary nail is normally used to prevent bone overgrowth into the proximal end of the nail and to facilitate nail removal at a later date. End cap migration into the proximal redundant space in the medullary canal behind the nail is rare but an avoidable complication. Maintenance of a fixed position of knee flexion during reaming and nail insertion and the use of Cannulated End Cap systems with Image control and may reduce the incidence of this complication.