Arthrodesis following persistent periprosthetic knee infection using femoral condyle allograft: a case report and review of literature

Periprosthetic joint infections (PJI) of the knee are difficult to treat and can require costly and prolonged hospital stays, weeks or months of antibiotic therapy, and multiple surgical procedures. Knee arthrodesis is considered a last resort for persistent knee joint infections and provides stability and pain relief by fusing the knee joint. The authors describe a case of a persistent and difficult to treat periprosthetic total knee arthroplasty (TKA) infection, subjected to multiple surgeries and revisions, where an arthrodesis was performed as a last resort. The arthrodesis was performed using a femoral-tibial endomedullary nail with interposed femoral condyle allograft. Complete graft integration and consolidation was achieved without complications. The patient performed well post-operatively and is currently ambulatory with walking aids and has no knee pain. The removal of well-fixed metaphyseal sleeves in TKA can be challenging and associated with complications such as damage to the surrounding bone and soft tissue during the removal process. Taking special care and not rushing this step can present an extremely meaningful difference in the final outcome. In cases with large bone defects, especially after sleeve removal, allograft usage can be extremely useful for managing dead space and limb-length discrepancies while promoting faster bone healing. When successful, as was the case described, arthrodesis using allografts can have beneficial outcomes with high patient satisfaction and deliver function to previously very unhealthy joints and limbs

Comparative study of radiological outcomes of intertrochanteric fractures managed with intra medullary nailing with or without intraoperative temporary K-wire’s stabilization

Background: Inter-trochanteric fractures are one of the most common hip fractures, occurring in both young adults and the elderly, as a result of high-energy trauma or low-energy trauma. These fractures are three to four times more common in elderly women with osteoporosis. The primary concern with Intertrochanteric fractures is the 20% to 30% mortality risk in the first year after the fracture. Methods: Various methods of fracture fixation have been used in treating this fracture with intramedullary nailing has been the most favoured. In this modality maintenance of reduction during and after fixation remains a concern. The temporary stabilization of  fracture with K-wires for minimally invasive fixation of Intertrochanteric fracture with an intramedullary nail is advocated and aids in keeping the fracture reduction in place while proximal reaming and nail introduction. Results: In this study a total of 80 patients with intertrochanteric fractures were included, of which 45 patients operated with temporary K-wire, 43 patients reduction was maintained and loss of reduction was noted in 2 patients (4.4%) and 35 patients operated without K-wire, 29 patients reduction maintained and lost in 6 patients (17.1%). Conclusions: There was no statistically significant, difference in the 2 groups with respect to intra/post-operative loss of reduction. Having a larger study group the results may have a statistically significant outcome

Day case orthopaedic trauma surgery effectiveness: a systematic review

Day case surgery facilitates effective orthopaedic care for ambulatory trauma cases and can act as an effective pathway in times of reduced resource availability within acute hospitals. A systematic review of the available literature was performed using a narrative synthesis to look for themes underpinning day case trauma practice. A 25 papers were selected from a total of 9956 papers screened to identify those papers that considered day case trauma surgery and its impact on clinical outcome, patient satisfaction and feasibility of delivery within the UK. 9014 patients had day case trauma operations within the 25 papers identified, 86% had general anaesthesia and 14% either regional or local anaesthesia. The mean reported age was 37.5 years with a wide age range (2-83) years treating roughly similar proportions of men and women with a high satisfaction rate when recorded. All areas of the upper limb were operated on apart from the scapula the commonest being the wrist. In the lower limb surgery was undertaken in the knee, ankle or foot with removal of foreign body or ankle fixation being the commonest procedures undertaken. Prevalence of complications at 0.0156% of cases undergoing day case surgery was seen to be lower than in a similar group of inpatient cases. resources are stretched. Day case surgery for trauma procedures within orthopaedics is safe, cost effective and well tolerated by patients. It frees up resources to facilitate treatment and should be utilised within each hospital to enable timely care

Femoropatellar alterations in knees with chronic anterior cruciate ligament injuries: a radiographic analysis

Background: The objective of this study was to correlate the occurrence of patellofemoral malalignment in a chronic anterior cruciate ligament (ACL) deficient knee using common radiological parameters. Methods: A case-control study was conducted on 35 adult patients with previously diagnosed unilateral chronic ACL injury. The injured knee was considered as the case, while the contralateral normal knee served as the control. Radiological parameters including the Caton-Deschamps patellar height index, Merchant patellar congruence angle, and Laurin lateral patellar tilt angle were measured on X-rays obtained from both normal and ACL injured knees. A comparative analysis was performed between the two groups. Results: The Caton-Deschamps patellar height index had a mean value of 0.95±0.05 in the ACL-deficient knee. The Merchant patellar congruence angle showed mean values of 12.66±0.84 degrees in the ACL injured knee, while the Laurin lateral patellar tilt angle was 8.06±1.41 degrees in knees with ACL failure. These results indicate lower patellar height, greater lateral displacement of the patella, and increased lateral patellar tilt in knees with chronic ACL tears, thereby affecting the patellofemoral joint. Conclusions: Chronic ACL tears are associated with patellofemoral malalignment, characterized by decreased patellar height, increased lateral displacement of the patella, and greater lateral patellar tilt, thus impacting the patellofemoral joint

Evaluation of the role of computed tomography guided biopsy in effective diagnosis and management of patients with Koch’s spine in India

Background: In the Indian population, tuberculosis and malignancy are the most common spinal pathologies. Radiological findings are often non-specific, thus non-diagnostic and fail to provide a prognostic perspective if the disease is established. Therefore, bacterial and/or histological evidence must be obtained to distinguish one infection from another or neoplasm. In this study, we evaluated the role of Computed Tomography-guided biopsy in Koch's spine by assessing diagnostic yield, the incidence of patients with drug-resistant tuberculosis, and drug sensitivity. Methods: Patients with suspected Koch's spine attending outpatient department of tertiary health care centre in India were selected for the study. Data were collected using proforma containing demographic, clinical, radiological and other laboratory variables. In addition, biopsy samples were sent for microbiological and histopathological analysis. Patients were followed up at an interval of 3 months to one year. Results: Most patients had Lumbar vertebra involvement followed by dorsal and least with cervical spine.41.25% of cases were drug resistant. In resistant cases, Isoniazid resistance is more seen, followed by Rifampicin. The clinical assessment revealed a significant difference in fever, back pain, Weight WBC count, Erythrocyte Sedimentation Rate and C Reactive Protein post-biopsy and treatment. Conclusions: Patients with Koch's spine should have tissue sampling for diagnosis and drug sensitivity; otherwise, they will not receive adequate treatment, leading to delayed recovery, disease worsening and resistance. Computed tomography guided biopsy thus helps early diagnosis and guides to proper anti-tuberculous treatment. In addition, it helps to decrease the burden of morbidity associated with Koch's spine

Comparison of American orthopedic foot and ankle society score between anterior to posterior lag screws versus posterior buttress plating for posterior malleolus fixation in tri-malleolar ankle fracture

Background: Posterior malleolar fractures are frequent, occurring in up to 44% of all ankle fractures. Surgical management typically involves anterior to posterior (AP) lag screws or posterior buttress plates. This study aimed to compare the AOFAS (American orthopedic foot and ankle society) score between AP lag screw and posterior buttress plating for posterior malleolus fixation in tri-malleolar ankle fracture. Methods: This quasi-experimental study was conducted at the department of orthopedics and traumatology, Chittagong medical college hospital, Chattogram, Bangladesh, from November 2020 to October 2021. It involved 28 patients with ankle fractures, equally divided into two groups. Group A received AP lag screw fixation, and group B underwent posterior buttress plating. Data analysis was performed using MS office tools and SPSS version 23.0. Results: The posterior plating group demonstrated superior postoperative AOFAS scores compared with the AP screw group with statistically significant differences (88 versus 81, p=0.008).  Significant differences were noted in the AOFAS pain score (p=0.045) and function score (p=0.019) at the final follow-up between the two groups. Conclusions: Patients with tri-malleolar ankle fractures in whom the posterior malleolus is treated with posterior buttress plating show superior postoperative AOFAS scores at follow-up compared to those treated with AP screws

Tuberculosis of the talus in a 2-year-old: a diagnostic dilemma

Extra-pulmonary tuberculosis involving the ankle and foot is a rare entity with its prevalence being ever rarer in the pediatric population. Here, we report the case of a two-year-old female child who presented with a gradually progressive non-traumatic swelling involving the right foot and ankle since two months. The patient was initially managed by a local doctor with immobilization of the foot and ankle in a slab for three weeks. Blood investigations were suggestive of an inflammatory process and a lytic lesion involving the talus was seen on radiographs. The patient was managed with debridement and curettage of the lesion along with anti-tubercular chemotherapy as per pediatric dosage for one year. The patient was asymptomatic at latest follow-up of one year and radiographs showed that lytic lesion had resolved

Advancing patient care: unleashing the potential of artificial intelligence in orthopaedics

I am writing to highlight the remarkable strides that artificial intelligence (AI) has taken in the field of orthopaedics, paving the way for transformative changes in patient care and clinical outcomes. As the realm of medical science evolves, integrating AI into orthopaedics has the potential to revolutionize diagnosis, treatment, and management strategies, enhancing both the precision and efficiency of orthopaedic care

Comparative study between interlock nailing and dynamic compression plating in humerus diaphyseal fractures in its functional and surgical outcome

Background: The aim of the study was to analyse compare study between interlock nailing and dynamic compression plating in humerus diaphyseal fractures in its functional and surgical outcome. Methods: The 2019 to 2022, patients were randomly divided into two groups with the help of computer-generated coded envelopes, group A (humerus diaphyseal fractures treated with dynamic compression plating) and group B (humerus diaphyseal fractures treated with interlock nailing) with 20 patients in each group. Outcomes were evaluated based on operative time, blood loss, neurovascular deficit, surgical site infection, union, shoulder stiffness, constant Murley score, Mayo elbow performance index at 1 year of follow up. Results: On radiology as non-union and union, most common study participants show union, on follow up of 1 year constant Murley score and Mayo elbow performance index was calculated and constant Murley score was more in patients treated with dynamic compression plating, shoulder stiffness was more in patients treated with interlock nailing. However blood loss was more in patients treated with dynamic compression plating. Conclusions: The result of our study shows that interlock nailing is associated with less blood loss but it is associated with decreased shoulder function postoperatively and marked shoulder stiffness which is more than patients treated with dynamic compression plating. Hence dynamic compression plating should be considered gold standard for operative treatment of humerus shaft fracture

Short and midterm functional and radiological outcomes of revision total hip arthroplasty with uncemented extensively porous coated monoblock cylindrical femoral stems

Background: This retrospective cohort study examines clinical and radiological outcomes of revision total hip arthroplasty (THA) using uncemented extensively porous coated mono block femoral stems. Methods: Patients who were operated for revision THA at medical college Baroda, between January 2008 to December 2018, and who had at least 36 months follow up were included in the study. Details were retrieved from hospital records. Harris hip score (HHS) was used for functional outcome and Paprosky classification was used for femoral bone defects. Results: Mean age of patients was 60.1 year (range 35-86 years), mean follow up was 84 months (range 40-126 months), Paprosky type 1 defect was found in 4 hips, type 2 was found in 20 hips and type 3a defect was found in 21 hips. Mean HHS improved from pre-operative 30 to post-operative 78 (p=0.0104). Expected survival at 5 and 10 years was more than 95%. No stem was loose at the end of follow up. Thigh pain and proximal osteolysis were most common complications. Conclusions: Extensively porous coated cylindrical stems give good functional and radiological outcomes at short and midterm follow up