Management of congenital vertical talus: comparison between mini invasive reduction and extensive surgical technique in early age

Background: About one baby in 10,000 is born with the foot deformity known as vertical talus. In about half of those cases, both feet are affected. The disorder occurs with equal frequency in boys and girls. Vertical talus is a rare deformity of the foot which is diagnosed at the time of birth.Methods: Present study was performed at Department of Orthopedics, Gujarat Adani Institute of Medical Science, Bhuj, Kutch, Gujarat. In the study 40 patients who were treated for unilateral or bilateral congenital vertical talus at a single institution which lead to 60 treated feet in the study. Patient with bilateral symptoms were randomly selected for one foot in the study.Results: The mean normative pain score was found to be 58.0 in the minimally invasive group compared with 28 in the extensive release group (p =0.032). There was no difference between the two groups in the transfer and basic mobility domain. The normative global function domain was higher in the minimally invasive group (48.3) compared with the extensive soft-tissue release group (34.3, p =0.03). Conclusions: Longer-term follow up and studies with large sample size are still necessary to determine whether the improved outcomes are maintained into the adulthood and whether the superior outcome is related to the reduce scarring in the patient

Intra articular hyaluronic acid injection, is it a wastage of money or justified?

Background: Osteoarthritis of knee (OA Knee) is one of the most common form of joint disease and affects everyone in different proportion with aging. To reduce the burden on society and improve the productive life various modalities of treatment are suggested. Our goal was to find out how much Intra Articular Hyaluronic acid injection (I/A HA inj.) is effective and safe.Methods: We have done a retrospective single blind study on 60 patients of OA Knee according to ACR Criteria, Grade I and II, who were treated with I/A HA inj. of a single brand. They were followed up up to 3 year after last injection and clinical assessment done based on VAS Scale and WOMAC Score.Results: Out of 60 patients who have been given I/A HA injection, patients below age of 50 and ACR Grade I OA Knee, responded well with injection. However patients above age of 50 and ACR Grade II OA Knee responded poorly and require some other form of treatment as early as 1 month after stopping injection.Conclusions: Though OA Knee is a degenerative disease which requires long term follow up to justify use of I/A HA injection, We believe that in early cases of OA Knee and Patients below age of 50 years, this treatment modality can work well and may prolong active life and delay surgical intervention and hence cost benefit ratio justifies use of this treatment modality.

Risk factors for septic arthritis of hip in neonates and infants

Background: Suppurative arthritis of hip is pyogenic inflammation of synovial membrane of the hip, usually due to bacterial infection. The main aim of early diagnosis and treatment of septic arthritis of hip is to prevent damage to articular cartilage and growth plate, give stable and painless hip and to resume normal development and prevent sequelae.Methods: Prospective interventional study consisted of 34 patients with 36 Hips septic arthritis of hip less than one year of age carried out at Department of Orthopedics of a tertiary care centre during August 2011 to December 2013. Risk factors and related laboratory investigations were carried out. Data entry and analysis was done by MS Excel 3.0.Results: In our study more than 70% patients presented after one week. Left sided hip involvement (59%) was more common followed by right hip (35%). Sex ratio of the study population was   M: F-4:6.  NICU admission was present in 94% cases.  In many of our patients there were more than one risk factors like septicemia, low birth weight, jaundice and ventilator support. Conclusions: All NICU neonates should be handled with strict aseptic precaution

Study of outcomes of metaphyseal plate fixation in extra articular lower tibia fractures in adults

Background: The purpose of the present study was to see results of metaphyseal plate fixation in fractures of distal tibia in adults.Methods: This is a retrospective study of 45 patients with 45 open fractures of tibia operated primarily by either Solid Titanium or Stainless steel tibia interlocking nail within 24 hours of injury.Results: In Our Study we had studied 30 lower tibial fractures treated by precontoured metaphyseal anatomical plate. 24 (80%) patients were male. 19 patients were 20-45 years age group. Mean age was 34 years. 24(80%) fractures were due to Road traffic accidents. We had 26 (86%) patients with closed fracture and 4(14%) patients with open fracture. Average time of surgery in our series was 52 minutes. 6(20%) patients had infection. And 2(6.67%) patients had nonunion and both were due to infection and required implant removal and conversion to external fixation. Average time for fracture union was 18 months. In our study of 30 patients 23(76.67%) patients had good to excellent results as assessed by AOFAS score. Conclusions: From this study we can conclude that when properly indicated the use of anatomically precontoured medial tibial metaphyseal plate in treatment of distal tibia fractures gives good union and good functional result

Effectiveness of Indirect Decompression in Severe Degenerative Lumbar Central Canal Stenosis by Oblique Lumbar Interbody Fusion

Objective To evaluate the efficacy of indirect decompression achieved by Oblique Lumbar Interbody Fusion in severe degenerative lumbar central canal stenosis in Schizas grade C and D according to pre-operative MRI and whether direct decompression was a necessity in such cases. The efficacy of indirect decompression is established for mild to moderate stenosis with instability. But insufficient data are available regarding its feasibility in Schizas grade C and D stenosis. Methods OLIF was carried out in 37 patients/44 segments, which fell into the category of Schizas grade C or D were included in the study. Clinical assessment was done using modified Macnab criteria. Percentage improvement in foraminal height, disc height, segmental lordosis, spinal canal area, and reduction in listhesis were measured. Patients were followed up for a period of a minimum of 1 year. Statistical analysis was done by Wilcoxon signed Ranks test, paired T-test, and Chi-square test. Results Clinically good to excellent result was achieved by OLIF in 94.59%. Radiologically, the average improvement in foraminal height was by 20.06%, disc height by 86.01%, segmental lordosis by 3.8° listhesis reduction by 51.8%, and spinal canal area by 75.36%. None required direct posterior decompression. Conclusion Indirect decompression is effective in Schizas grade C and D stenosis with early excellent to good results clinically. There is improvement in disc height, foraminal height, segmental lordosis, and overall spinal canal area by OLIF (Study design: retrospective)

Comparison study of compound fractures of tibial shaft treated by titanium and stainless steel interlocking nails

Background: The purpose of the present study was to compare the outcomes of compound fractures of tibia shaft managed by Solid Titanium and Stainless Steel interlocking intramedullary nailing.Methods: This is a retrospective study of 45 patients with 45 open fractures of tibia shaft operated primarily by either Solid Titanium or Stainless steel tibia interlocking nail.Results: In Our Study we had 45 patients with 45 open tibial fractures. All were male. 35 patients were from 20-50 years age group. Mean age was 36.4 years. In this study of 45 open tibial fractures following strict protocol of thorough debridement, primary wound closure and Solid Titanium or stainless steel interlocking nailing; it was observed at final follow up that patients operated by titanium nail compared to stainless steel had 6.45% vs. 14.29% infection rate, 12.9% vs. 21.89% rate of non-union and 3.22% vs. 7.14% screw breakage rate. According to modified ketenjian’s criteria in our study out of 31 patients operated by Titanium interlocking nail 17 (54.84%) excellent, 10 (32.26%) Good, 3(9.68%) fair and 1(3.22%) poor functional results while out of 14 patients managed by stainless steel nail 8 (57.14%) excellent, 3 (21.43%) good, 1 (7.14%) fair and 2 (14.28%) poor functional results. Conclusions: In open tibial fractures titanium interlocking implants offer lower complication rate as compared to stainless steel implants and better overall patient outcome

Comparison study for internal and external modes of fixation for fractures of distal end radius

Background: Fractures of the distal radius continue to be one of the most common skeletal injuries. The methods which are commonly practiced are closed manipulation and plaster cast, pins and plaster, percutaneous pinning, external fixation and open reduction and internal fixation with or without bone graft. Surgeons are increasingly faced with the dilemma of when to consider operative management and when cast immobilization is the optimal treatment.Methods: 47 cases of distal end radius fractures were operated in the orthopedic department of a tertiary care centre. The purpose of the present study was to compare the results of external and internal fixation methods for the treatment of fractures of distal end of radius. Patients operated by external fixation were classified as Group A and those operated by internal fixation were classified as group B. Patients were classified according to AO Classification. Patients were followed at regular intervals depending on the case and time of operation and evaluated by Gartland and Werley score.Results: In our study, 29 patients were of extraarticular type, of which 86.20% had an excellent score and 18 patients were of intraarticular type, of which 83.33% had an excellent score. But when compared to groups A and B, the percentage of excellent score obtained in group B was more than that in group A in both extraarticular and intraarticular fractures. Yuan-kun et al did a study on intraarticular distal end radius fractures and evaluated the patients by Gartland and Werley point system, concluding that plating gives better results than external fixation supplemented by K wiring. Conclusions: We concluded that no method of fixation can be said superior to the other. Each method has fracture-specific indication. The results of open reduction and internal fixation can be better than external fixation in initial months, but in the long run, both the methods can have excellent score, provided the fixation is good and properly indicated

MRI Study to Evaluate Anatomic Oblique Lumbar Interbody Fusion Corridor in Indian Population

Objective The anatomic corridor is defined by different studies in the western population but the exact corridor for the Indian population is never been studied. Objective of the study was to define anatomical corridor for preoperative assessment of Oblique Lumbar Interbody Fusion (OLIF) in the Indian population. Methods We selected imaging data from 180 adults (90 males and 90 females) who underwent MRI. The windows studied at L1-2 to L4-5 levels were vascular window, bare window, psoas major window, and operative window. The bare window was further analysed by dividing it into three groups. Group 1 with no window, group 2 with 0 to 5 mm window, and group 3 with more than 5 mm. Statistical analysis was carried out by unpaired t-test. Results The bare window was largest at L1-2 (1.29 ± 0.53 cm) and smallest at L4-5 (0.79 ± 0.52 cm). The psoas major window was largest at L3-4 (1.24±0.38 cm) and smallest at L1-2 (0.45±0.47 cm). The operative window was largest at L3-4 (2.4±0.47 cm) and smallest at L4-5 (1.72 ± 0.67 cm). In 10.56% of patients at L4-5, there was no bare window and OLIF cannot be performed in these patients. Conclusion Bare window gradually decreases from L12 to L45 levels. In the majority of patients at L12, L23, and L34 there is adequate bare window and OLIF can be safely performed. In 10.56% of patients, the bare window for performing OLIF does not exist at L45 and OLIF may not be feasible in these patients

To study surgical outcome of various surgical procedures of lateral release in valgus knee in total knee arthroplasty

Background: Fixed valgus deformity presents a major challenge in total knee arthroplasty (TKA), especially in moderate or severe cases. In knee arthritis, fixed-varus deformity (50 to 55%) is three times more frequent than fixed-valgus deformity (10 to 15%). Valgus deformity occurs more commonly in rheumatoid arthritis and also in osteoarthritis with hypoplasia of the lateral femoral condyle. Valgus deformity is often associated with flexion or external rotation contracture of the knee. In this study we aim to study the surgical outcome of total knee replacement in valgus deformity via standard medial parapatellar approach using various techniques like Pie –Crusting release of lateral structures or combined technique of pie crusting and standard release of lateral structures. Aim: To evaluate surgical outcome of various surgical techniques via standard medial parapatellar approach in fixed valgus deformity in Total Knee Arthroplasty.Methods: The present study involved both male and female patients with osteoarthritis of knee with valgus deformity. In present series, 26 consecutive patients of osteoarthritis with valgus deformity operated with total knee replacement were included. Previously operated cases of high tibial osteotomy and patients having contraindication for TKA were excluded from the study.Results: Valgus angle in this study was between 13 to 27 degree with average 17.84 degree. These results were comparable to many such similar studies. In our study, post operatively, knee society score was average 87.69 and function knee score was 82.5. Mean range of motion was 105 degree. In our study, mean tibiofemoral alignment improved from 17.84 valgus to 4.7 valgus.Conclusions: Knee society score is excellent with both techniques and there is no difference in both techniques Iliotibial band and posterolateral capsule are most common structures that require release. Initial ligament balancing should be done with pie crusting and then sequential lateral release if require.