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   Table of Contents - Current issue
July-December 2022
Volume 30 | Issue 2
Page Nos. 29-74

Online since Saturday, December 24, 2022

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Publication ethics: Points to be pondered p. 29
Sanjay Keshkar, Kiran Kumar Mukhopadyay
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Decision-making of trochanteric fractures in elderly Highly accessed article p. 32
Saumitra Misra
Many factors contribute to decision making for success or failure in the management of trochanteric fractures. The purpose of this article is to address key operative decisions pertaining to these factors with evidence from current literature.
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Management of unstable trochanteric fracture in elderly p. 35
Ananda Kisor Pal
Fracture around the trochanter is one of the most common fractures of the hip especially in the elderly with osteoporotic bones, usually due to low-energy trauma like simple falls within the height of individual. The unstable trochanteric fractures with poor bone quality require accurate planning and judicial surgical management for their osteosynthesis by stable fixation as well as strict postoperative care to avoid fixation failure. The purpose of this article is to discuss management of unstable trochanteric fractures.
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Intertrochanteric fracture: Relevant anatomy and classification p. 39
Ratnesh Kumar, Ananda Kisor Pal, Sanjay Keshkar
Intertrochanteric fracture is one of the most common fractures around the hip especially in the elderly due to trivial trauma. This fracture is encountered by almost all Orthopaedic surgeon and hence appropriate knowledge of relevant anatomy and classification is very important to deal with such fractures. This article will highlight the relevant anatomy of intertrochanteric area and will provide an overview of various classification systems.
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Initial results of halifax nail in elderly intertrochanteric fracture p. 45
Akhilesh Kumar, Joydeep Das, Phagu Ram Majhi, Rajeev Raman
Background: Variety of implants (extramedullary and intramedullary) are available to fix intertrochanteric (IT) fracture but hardly any data is available that proves the superiority of one over other. Every implant is having its own advantage and disadvantages. The aim of this study is to analyze the results of Halifax nail in age group of 60 to 100 year age group. Materials and Methods: Total 15 cases of intertrochanteric fracture operated using Halifax nail in which youngest patient was 60 years male and oldest was 95 years female.13 cases operated in same hospital and 2 in two different hospitals. These patient were chosen randomly among elderly IT fracture admitted in hospital during August 2017 to January 2019. Results are analyze in term of Mobilization, pain control, union time, implant failure. Final outcome was evaluated as per Harris Hip Score. Result: Among 15 cases,13 follow up available, 2 patient were lost in follow up after natural death. Out of 13 patients (n = 13), 7 showed excellent, 5 showed good and one patient showed poor result as per Harris Hip Score. Conclusion: Results of Halifax nail for IT fractures in elderly was found to be highly encouraging. All patients had early union and none had implant failure. Early mobilization and negligible mortality and morbidity were other added advantages.
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Functional outcome of long proximal femoral nail versus short proximal femoral nail in peri-trochanteric fractures in elderly patient p. 49
Chinmoy Das, Kunal Phukan, Udit Kushwaha
Background: Intertrochanteric fractures account for 5% of all hip fractures and 35–40% of these fractures are unstable three or four part fractures. Operative treatment is the best option in most of the trochanteric fractures. Evolution of intramedullary devices is a result of dissatisfaction with the extra medullary devices in intertrochanteric unstable fractures. Intramedullary nailing, with less operative time and less operative blood loss allows early weight bearing with less resultant shortening on long term follow up. Our main aim was to compare the effectiveness and drawbacks of short proximal femoral nail (PFN) versus long PFN in the management of peri-trochanteric fractures. Materials and Methods: This study was randomized, time bound, hospital based study conducted in a tertiary hospital, between April 2019 to April 2022. The study included 41 cases of unstable peri-trochanteric fractures divided into two groups. Patients of Group-I were operated with Short PFN and Group-II were operated with Long PFN by standard technique. Intraoperative parameters, post-operative data and events were noted. During follow-ups, patients were assessed by clinico-radiological evaluation and Harris hip score. Results: Total of 41 patients of peri-trochanteric fracture have been included in study out of which 24 belonged to Group-I and were operated with short PFN and rest 17 were of Group-II operated with long PFN. Though there was no significant difference in results of two Groups but use of Long PFN was found to be advantages over Short PFN in terms of the less postoperative complications, less mean time of union and better lower extremity functional scores. Conclusion: In our short term results, it was evident that the use of Long PFN has advantages over Short PFN in terms of the less postoperative complications, less mean time of union and better lower extremity functional scores. A study with a larger sample size would have made a better assessment of this surgical intervention.
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Management of neglected femoral neck fracture in young adolescents with modified pauwels osteotomy p. 53
Chinmoy Das, Ahmad Saifuddin, Debasish Bora
Background: Non-union of the femoral neck fracture in young is difficult to tackle. Many reported treatment methods for neglected femoral neck fractures do not always satisfactorily address the problems like non-union,coxa vara, and limb shortening. If the femoral head is viable, the most appropriate treatment is valgus osteotomy, which increases the femoral neck angle to change shearing force to compression force. We prospectively reviewed the functional outcome of the modified Pauwels’ osteotomy in 16 young adults to determine whether this approach would correct those problems. Materials and Methods: A total of 16 cases of neck femur fracture in less than or equal to 16 year old neglected for more than 12 weeks were included in our study and were treated primarily by modified Pauwels intertrochanteric osteotomy with internal fixation. The patients were followed up to 12–24 months with radiography and were assessed regarding Harris hip score, unionand limb length discrepancy. Results: Union was seen in all the 16 patients .11 out of the 16 patients showed excellent clinical outcome (Harris hip score ≥ 90) with an average Harris score of 90.1 ± 6. Conclusion: Modified Pauwels’ Intertrochanteric Osteotomy is a safe and effective procedure in preserving the God gifted hip in neglected femoral neck fracture
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Sacralisation-changing concept p. 59
Kiran Kumar Mukhopadyay
Low back pain is a common complaint among middle aged and elderly persons. There are many causes but one of it could be sacralisation of lumbar vertebra. Sacralisation means addition of sacral elements by the incorporation of the fifth lumbar vertebra. The incorporation of the fifth lumbar vertebra with the sacrum may be unilateral or bilateral producing partial or complete sacralisation. Sacralisation is commonly regarded as a cause of altered patterns of degenerative spine changes. This review will focus on whether sacralisation of the fifth lumbar vertebra is a radiological entity or a clinical entity.
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Extended trochanteric osteotomy for recurrent dislocation in primary total hip replacement-A case report p. 62
Abhijit Bandyopadhyay, Sanjay Kumar
Dislocation after primary total hip replacement (THR) elicits significant morbidity and also affects the quality of life. Various patients and surgery related factors are the predictors of dislocation. The present case describes with six major prior surgeries for dislocation with a long cemented stem as a major reason. After complete evaluation, our plan was extended trochanteric osteotomy for cement removal followed by distal fit interlocked long stem, use of constrained acetabular liner and a larger head. At 5th post-operative day, patient had good functional outcome and no radiographic evidence of complications.
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Late isolated comminuted trapezium fracture with carpometacarpal subluxation: A case report p. 67
Arya Roy, Sumon Dutta, Gaur Gautam Kar
Trapezium fracture is the third most commonly occurring fracture in carpal bones, in most author series, but isolated and severely comminuted fracture with carpometacarpal subluxation is extremely rare. We report a case of a 24-year-old man who sustained a closed comminuted trapezium fracture on his left hand, with trapezio-metacarpal subluxation, presented 3 weeks after injury. He was treated by open reduction and fixation by two mini screws and provisional stabilisation of first carpometacarpal joint by two Kirshner wires. Satisfactory outcome was achieved at 6-month follow-up.
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Our legend: Prof. A.K. Das p. 70
Sanjay Keshkar, Dilip Kumar Mazumder
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From orthopaedic museum: The “Sen’s nail” p. 72
Tapas Chakraburtty, Sanjay Keshkar, Dilip Kumar Mazumder
Orthopaedics in India is developed by many stalwarts by the dint of their inventions and innovations. Sen’s nail is one of them that were invented by Prof. (Dr.) Biswajit Sen from Kolkata, India, in 1973 as a solution to deal with peritrochanteric fractures in elderly. Though the “Sen’s nail” is not in use now a days (because of the advent of newer and better implant and technology for such fractures), it is absolutely imperative to convey to posterity about this lifetime work and obsession of Prof. (Dr.) Biswajit Sen.
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