Management of Flexion Contracture in Total Knee Arthroplasty

Fixed flexion deformity at knee is common in osteoarthritic knee and is a combination of bony deformity, capsular and ligamentous deformity. It affects knee biomechanics in terms of increased forces at the patellofemoral and tibiofemoral joint. This in turn makes carrying out of routine daily activities like walking or use of staircase very difficult. Therefore, it is essential to correct this deformity at the time of operative intervention. Major interventions like posterior capsular release and removal of osteophytes and adequate bony resection helps in correcting the deformity. Post operatively, use of extension night splints and adequate physiotherapy can help in correcting the residual deformity left over at the time of knee arthroplasty

Single-Bundle Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures performed in orthopedics. The research has focused extensively on surgical technique factors like tunnel position, graft choices, fixation methods, and rehabilitation protocols following surgery. The advantages and disadvantages of each graft option shall help in deciding the correct graft in an individual case. A thorough understanding of anatomy and biomechanics of normal ACL has improved the understanding of complexities of knee joint stabilization over the preceding decades. The chapter shall discuss in detail about the anatomy, biomechanics, and surgical techniques along with postoperative rehabilitation protocol in current perspective

EFFICACY AND SAFETY OF KNOTLESS BARBED SUTURES IN CAPSULAR CLOSURE FOLLOWING DISTAL FEMUR FRACTURE FIXATION

ABSTRACT Introduction: Good wound closure is an important step in management of distal femur fracture to prevent infection and faster rehabilitation. Knotless barbed sutures can save time and distribute wound tension evenly. However, its role in terms of functional outcome, closure time, and postoperative complications has not been studied in a distal femur fracture. Material and methods: A total of 47 patients aged more than 18 years of distal femur fracture treated with distal femur locking plate were randomized either into either barbed or traditional suture groups. in the barbed group, capsular wound closure was carried out with 2-0 bidirectional barbed knotless sutures (Quill SRS® PDO, Angiotech, Vancouver, BC, Canada). In patients assigned to group B, capsular closure was done with 1-0 Vicryl® (Ethicon inc. Somerville, NJ) and 5-0 Ethibond® alternatively. Results: The mean flexion at the knee joint was 105.7±15.6 degrees in the study group while it was 110.4±13.7 in the control group (p= 0.2133). Mean estimated closure time was significantly shorter in the study group as compared to the control group (p<0.05). Cases of needle prick injury were higher in traditional suture group. Patients developed stitch abscess and superficial infection in both groups. However, the difference in incidence between the two was not statistically significant Conclusion: Barbed suture is an efficient method of wound closure. It reduces wound closure time with similar complication rate as with use of conventional sutures. Evidence Level II; Randomized Clinical Trial

Neglected Thoraco Lumbar Traumatic Spine Injuries

Study DesignRetrospective study.PurposeTo outline the etiology, complications and management difficulties encountered in the management of neglected thoracolumbar spine injuries.Overview of LiteratureThe English literature describes overlooked diagnosis as the most common cause of neglected spine injuries. However, the reasons differ in developing or under-developed nations. Moreover, there is scarcity of literature about the neglected spinal injuries.MethodsPatients presenting with thoracolumbar traumatic injuries who had not received any form of treatment for more than three weeks were included in the study. The demographic details, operative procedure performed and complications encountered, along with American Spinal Injury Association grade and spinal cord independence measure score recorded on the history sheets were noted. The data were analyzed.ResultsForty patients were included in the study. Inadequate treatment at the first contact hospital (45%) followed by late presentation (38%) and missed injury (17%) were the major etiological factors for the neglected traumatic injuries in the thoracolumbar spine. The most common complications seen in the management of these cases were pressure sores (58%), back pain (57%), urinary tract infection (42%) and residual kyphotic deformity (42%).ConclusionsManagement of neglected thoracolumbar injuries is challenging. The delay in presentation should not prevent spine surgeon in proceeding with operative intervention as good results can be expected

Assessment of vitamin D status in rheumatoid arthritis patients

Background: Vitamin D is a secosteroid hormone involved in bone and calcium metabolism. It is involved in the regulation of calcium homeostasis, as it regulates calcium absorption from the gastrointestinal system. The present study was conducted to assess vitamin D status in RA patients. Materials &amp; Methods: 112 Rheumatoid arthritis patients of both genders were put in group I. Healthy subjects were also enrolled and put in group II. Disease activity score of RA patients was calculated. Disease severity was assessed according to the value of DAS28 score as follows- Remission: DAS28 ≤2.6 Low disease activity: 2.6 5.1. 25 (OH)-Vitamin D Xpress ELISA Kit was used for the quantitative measurement of Vitamin D3 {25 (OH)-D3} in serum. Results: Group I had 62 males and 50 females and group II had 70 males and 42 females. Disease activity was remission, low, moderate and high with mean serum calcium level (mg/dl) as 8.92, 8.34, 8.22 and 8.01 and vitamin D (mg/dl) as 35.6, 31.4, 22.3 and 14.8 respectively.&nbsp

Complications in the management of closed high-energy proximal tibial plateau fractures

Purpose: To report complications in the management of complex closed proximal tibial fractures. Method: A retrospective study was conducted to analyze the infectious and noninfectious complications encountered in the management of high-energy Schatzker type V and VI tibial plateau fractures. All patients were treated at the level 1 trauma centre between January 2011 and March 2014. Sixty two patients were included in the study. The mean patient age was (43.16 ± 11.59) years with 60 males and 2 females. Infectious complications like superficial and deep infection, wound dehiscence, malalignment in the immediate postoperative period and in follow-up period were noted. Results: The overall complication rate was 30.65% (19 out of 62). Infectious complications were noted in 20.97% cases (13/62). In majority of the cases (8/13), superficial infection was seen which managed with regular dressing and antibiotic administration. The patients (5/13) who had developed deep-seated infection were subjected to repeated debridements, flap coverage, implant removal or amputation depending upon the host response. Thirteen patients had experienced noninfectious complications. Hardware related complications were noticed in six patients and four among them received a secondary procedure. Malalignment was observed in seven patients but only single patient underwent subsequent operative intervention. Conclusion: Proximal tibial plateau fractures especially Shatzker type V and VI are associated with extensive soft tissue damage even in closed injuries. The complications encountered in the management of these fractures can be minimized with appropriate patient selection and minimal soft tissue dissection