Coronal malalignment of the knee joint is very common in developing countries especially because ... more Coronal malalignment of the knee joint is very common in developing countries especially because of nutritional rickets. Significant valgus deformity needs to be treated surgically to improve appearance, gait and function of the patient. The purpose of this prospective study was to evaluate the results of supracondylar "V" osteotomy as a surgical technique for correction of the valgus knee deformity. This study was conducted in a tertiary level teaching hospital and 30 cases were included in the study. For all the patients deformity was assessed using ana- tomical tibiofemoral angle, mechanical axis deviation and intermalleolar distance preoperatively and post- operatively. The average age of our patients was 13.7 years and the average follow up was3.29 years (1.39-14.22 yrs). Clinically the average value of intermalleolar distance preoperatively was 16cm and 3.2 cm postperatively. Average pre-operative tibiofemoral angle was 23° and the average postoperative angle was 6 0 which was found to be statistically significant using the Paired t test (p<0.005). The average value of preoperative mechanical axis deviation was 3.1 cm which decreased to an average value of 1.1 cm postoperatively. The results with this technique have been encouraging. The advantages of this technique are low morbidity, good stability allowing early ambulation, ability to adjust alignment postoperatively by casting and no need for internal fixation. Few studies have been conducted on osteotomies that do not require internal fixation and are inherently stable. This technique has the advantage of practically no occurrence of any infection or a second surgery to remove hardware in children and adolescents. Since no specialized instrumentation, image intensifier and implants are required, it is cost effective and can be used in any primary care or district level surgical setup in a developing country like ours.
Journal of orthopedics, traumatology and rehabilitation, 2015
Purpose: Clavicle fracture traditionally treated conservatively. There is a growing trend to trea... more Purpose: Clavicle fracture traditionally treated conservatively. There is a growing trend to treat displaced mid-shaft clavicular fractures with primary open reduction and plate fixation; whether such treatment results in improved patient outcomes is debatable. The aim of this study was to compare union rates and functional outcomes for displaced mid-shaft clavicular fractures that were treated with either primary open reduction and plate fixation or nonoperative treatment. Material and Methods: In this prospective study, 32 patients between 18 and 60 years of age who had an acute displaced mid-shaft clavicular fracture were randomized to receive either primary open reduction and plate fixation (n = 12) or nonoperative treatment (n = 20). Functional assessment was conducted at 3 months, 6 months, and 1-year with the use of the constant scores. Union was evaluated clinically and radiographically. Complications were recorded and compared. Results: The rate of nonunion was significantly reduced after open reduction and plate fixation (none nonunion) as compared with nonoperative treatment (two nonunion). Constant scores were significantly better after open reduction and plate fixation than after nonoperative treatment; 93.7 versus 85.5. A major complication was found in 35% of patients in the conservative group while they were absent in operative group. Conclusions: Open reduction and plate fixation reduces the rate of nonunion after acute displaced mid-shaft clavicular fracture compared with nonoperative treatment and is associated with better functional outcomes. Open reduction and plate fixation using precontoured locking plate have low implant-related complications.
Introduction: Intertrochanteric femur fracture incidence has increased due to increased life expe... more Introduction: Intertrochanteric femur fracture incidence has increased due to increased life expectancy and osteoporosis. Management of these fractures in elderly is challenging due to difficult anatomical reduction, poor bone quality and osteoporosis. Internal fixation in these cases usually involves prolonged bed rest to prevent implant failure which leads higher complication such as deep vein thrombosis, pneumonia pulmonary embolism, bed sores, increased morbidity. Materials and Methods: We have done a prospective study in 18 cases of unstable intertrochanteric fracture where 12 (not associated hip arthritis) patients are operated by bipolar hemiarthroplasty and 6 (associated hip arthritis) patients operated by total hip arthroplasty (THA). Results: Patients were followed for an average of 12 months duration (9-15 months). Patients treated by bipolar hemiarthroplasty group (Group 1) have an average surgery duration of 95 min and blood loss of 315 ml. While patients treated with THA (Group 2) has average surgery duration of 152 min, blood loss of 565 ml. About 91% of 1 st group and 100% of 2 nd group has an excellent to fair outcome. Conclusion: Bipolar hemiarthroplasty for unstable intertrochanteric fracture femur without hip arthritis, and THA for intertrochanteric fracture with hip arthritis in elderly patient results in early ambulation and good functional outcome. However, as our study group is small, so further large randomized trail required before reaching conclusion.
Coronal malalignment of the knee joint is very common in developing countries especially because ... more Coronal malalignment of the knee joint is very common in developing countries especially because of nutritional rickets. Significant valgus deformity needs to be treated surgically to improve appearance, gait and function of the patient. The purpose of this prospective study was to evaluate the results of supracondylar "V" osteotomy as a surgical technique for correction of the valgus knee deformity. This study was conducted in a tertiary level teaching hospital and 30 cases were included in the study. For all the patients deformity was assessed using ana- tomical tibiofemoral angle, mechanical axis deviation and intermalleolar distance preoperatively and post- operatively. The average age of our patients was 13.7 years and the average follow up was3.29 years (1.39-14.22 yrs). Clinically the average value of intermalleolar distance preoperatively was 16cm and 3.2 cm postperatively. Average pre-operative tibiofemoral angle was 23° and the average postoperative angle was 6 0...
Introduction It is not uncommon to encounter patients with atypical hip or lower extremity pain, ... more Introduction It is not uncommon to encounter patients with atypical hip or lower extremity pain, ill-defined clinico-radiological features and concomitant hip and lumbar spine arthritis. It has been hypothesized that an anaesthetic hip arthrogram can help identify the source of pain in these cases. The purpose of this study is to analyze our experience with this technique in order to verify its accuracy. Methods We undertook a retrospective analysis of 204 patients who underwent a hip anesthetic-steroid arthrogram for diagnostic purposes matching our inclusion criteria. Patient charts were scrutinized carefully for outcomes of arthrogram and treatment. Harris Hip Score was used to quantify outcome. Results The results show that out of 204, 162 patients had positive and 42 had negative response to arthrogram. Of the positive responders (N=162), 76 underwent uncemented Total Hip Arthroplasty (THA), all with good results, and the rest are being treated conservatively. From the negative...
Osteoarthritis (OA) is an increasingly important public health problem [1]. It is slowly progress... more Osteoarthritis (OA) is an increasingly important public health problem [1]. It is slowly progressive, can cause symptoms ranging from mild to disabiling. Osteoarthritis is a common cause of knee pain especially in the elderly. It is characterised by loss of articular cartilage, subchondral sclerosis, joint deterioration and osteophyte formation [1]. The current treatment for knee OA consists of conservative treatment such as exercise, physical therapy, pharmacological agents and, in some cases surgical treatment [2,3]. While many of the commonly used conservative treatments have been recognised to be effective [4], there is still insufficient evidence available. Among the pharmacological treatments for knee OA, oral non-steroidal anti-inflammatory drugs (NSAIDs) act rapidly and are recommended for the management of OA, although frequent and serious adverse effects of NSAIDs have been recognized [4] . The normal adult knee contains approximately 3.0 mL of synovial fluid (SF), with a ...
Journal of Bone Joint Surgery British Volume, May 1, 2011
Abstract Introduction: Failure of internal fixation of intertrochanteric fractures may be associa... more Abstract Introduction: Failure of internal fixation of intertrochanteric fractures may be associated with delayed union or malunion resulting in persistent pain and diminished function. The purpose of this study is to evaluate results of the use of a tapered, fluted, ...
Coronal malalignment of the knee joint is very common in developing countries especially because ... more Coronal malalignment of the knee joint is very common in developing countries especially because of nutritional rickets. Significant valgus deformity needs to be treated surgically to improve appearance, gait and function of the patient. The purpose of this prospective study was to evaluate the results of supracondylar "V" osteotomy as a surgical technique for correction of the valgus knee deformity. This study was conducted in a tertiary level teaching hospital and 30 cases were included in the study. For all the patients deformity was assessed using ana- tomical tibiofemoral angle, mechanical axis deviation and intermalleolar distance preoperatively and post- operatively. The average age of our patients was 13.7 years and the average follow up was3.29 years (1.39-14.22 yrs). Clinically the average value of intermalleolar distance preoperatively was 16cm and 3.2 cm postperatively. Average pre-operative tibiofemoral angle was 23° and the average postoperative angle was 6 0 which was found to be statistically significant using the Paired t test (p<0.005). The average value of preoperative mechanical axis deviation was 3.1 cm which decreased to an average value of 1.1 cm postoperatively. The results with this technique have been encouraging. The advantages of this technique are low morbidity, good stability allowing early ambulation, ability to adjust alignment postoperatively by casting and no need for internal fixation. Few studies have been conducted on osteotomies that do not require internal fixation and are inherently stable. This technique has the advantage of practically no occurrence of any infection or a second surgery to remove hardware in children and adolescents. Since no specialized instrumentation, image intensifier and implants are required, it is cost effective and can be used in any primary care or district level surgical setup in a developing country like ours.
Journal of orthopedics, traumatology and rehabilitation, 2015
Purpose: Clavicle fracture traditionally treated conservatively. There is a growing trend to trea... more Purpose: Clavicle fracture traditionally treated conservatively. There is a growing trend to treat displaced mid-shaft clavicular fractures with primary open reduction and plate fixation; whether such treatment results in improved patient outcomes is debatable. The aim of this study was to compare union rates and functional outcomes for displaced mid-shaft clavicular fractures that were treated with either primary open reduction and plate fixation or nonoperative treatment. Material and Methods: In this prospective study, 32 patients between 18 and 60 years of age who had an acute displaced mid-shaft clavicular fracture were randomized to receive either primary open reduction and plate fixation (n = 12) or nonoperative treatment (n = 20). Functional assessment was conducted at 3 months, 6 months, and 1-year with the use of the constant scores. Union was evaluated clinically and radiographically. Complications were recorded and compared. Results: The rate of nonunion was significantly reduced after open reduction and plate fixation (none nonunion) as compared with nonoperative treatment (two nonunion). Constant scores were significantly better after open reduction and plate fixation than after nonoperative treatment; 93.7 versus 85.5. A major complication was found in 35% of patients in the conservative group while they were absent in operative group. Conclusions: Open reduction and plate fixation reduces the rate of nonunion after acute displaced mid-shaft clavicular fracture compared with nonoperative treatment and is associated with better functional outcomes. Open reduction and plate fixation using precontoured locking plate have low implant-related complications.
Introduction: Intertrochanteric femur fracture incidence has increased due to increased life expe... more Introduction: Intertrochanteric femur fracture incidence has increased due to increased life expectancy and osteoporosis. Management of these fractures in elderly is challenging due to difficult anatomical reduction, poor bone quality and osteoporosis. Internal fixation in these cases usually involves prolonged bed rest to prevent implant failure which leads higher complication such as deep vein thrombosis, pneumonia pulmonary embolism, bed sores, increased morbidity. Materials and Methods: We have done a prospective study in 18 cases of unstable intertrochanteric fracture where 12 (not associated hip arthritis) patients are operated by bipolar hemiarthroplasty and 6 (associated hip arthritis) patients operated by total hip arthroplasty (THA). Results: Patients were followed for an average of 12 months duration (9-15 months). Patients treated by bipolar hemiarthroplasty group (Group 1) have an average surgery duration of 95 min and blood loss of 315 ml. While patients treated with THA (Group 2) has average surgery duration of 152 min, blood loss of 565 ml. About 91% of 1 st group and 100% of 2 nd group has an excellent to fair outcome. Conclusion: Bipolar hemiarthroplasty for unstable intertrochanteric fracture femur without hip arthritis, and THA for intertrochanteric fracture with hip arthritis in elderly patient results in early ambulation and good functional outcome. However, as our study group is small, so further large randomized trail required before reaching conclusion.
Coronal malalignment of the knee joint is very common in developing countries especially because ... more Coronal malalignment of the knee joint is very common in developing countries especially because of nutritional rickets. Significant valgus deformity needs to be treated surgically to improve appearance, gait and function of the patient. The purpose of this prospective study was to evaluate the results of supracondylar "V" osteotomy as a surgical technique for correction of the valgus knee deformity. This study was conducted in a tertiary level teaching hospital and 30 cases were included in the study. For all the patients deformity was assessed using ana- tomical tibiofemoral angle, mechanical axis deviation and intermalleolar distance preoperatively and post- operatively. The average age of our patients was 13.7 years and the average follow up was3.29 years (1.39-14.22 yrs). Clinically the average value of intermalleolar distance preoperatively was 16cm and 3.2 cm postperatively. Average pre-operative tibiofemoral angle was 23° and the average postoperative angle was 6 0...
Introduction It is not uncommon to encounter patients with atypical hip or lower extremity pain, ... more Introduction It is not uncommon to encounter patients with atypical hip or lower extremity pain, ill-defined clinico-radiological features and concomitant hip and lumbar spine arthritis. It has been hypothesized that an anaesthetic hip arthrogram can help identify the source of pain in these cases. The purpose of this study is to analyze our experience with this technique in order to verify its accuracy. Methods We undertook a retrospective analysis of 204 patients who underwent a hip anesthetic-steroid arthrogram for diagnostic purposes matching our inclusion criteria. Patient charts were scrutinized carefully for outcomes of arthrogram and treatment. Harris Hip Score was used to quantify outcome. Results The results show that out of 204, 162 patients had positive and 42 had negative response to arthrogram. Of the positive responders (N=162), 76 underwent uncemented Total Hip Arthroplasty (THA), all with good results, and the rest are being treated conservatively. From the negative...
Osteoarthritis (OA) is an increasingly important public health problem [1]. It is slowly progress... more Osteoarthritis (OA) is an increasingly important public health problem [1]. It is slowly progressive, can cause symptoms ranging from mild to disabiling. Osteoarthritis is a common cause of knee pain especially in the elderly. It is characterised by loss of articular cartilage, subchondral sclerosis, joint deterioration and osteophyte formation [1]. The current treatment for knee OA consists of conservative treatment such as exercise, physical therapy, pharmacological agents and, in some cases surgical treatment [2,3]. While many of the commonly used conservative treatments have been recognised to be effective [4], there is still insufficient evidence available. Among the pharmacological treatments for knee OA, oral non-steroidal anti-inflammatory drugs (NSAIDs) act rapidly and are recommended for the management of OA, although frequent and serious adverse effects of NSAIDs have been recognized [4] . The normal adult knee contains approximately 3.0 mL of synovial fluid (SF), with a ...
Journal of Bone Joint Surgery British Volume, May 1, 2011
Abstract Introduction: Failure of internal fixation of intertrochanteric fractures may be associa... more Abstract Introduction: Failure of internal fixation of intertrochanteric fractures may be associated with delayed union or malunion resulting in persistent pain and diminished function. The purpose of this study is to evaluate results of the use of a tapered, fluted, ...
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