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   Table of Contents - Current issue
January-June 2022
Volume 30 | Issue 1
Page Nos. 1-28

Online since Thursday, June 30, 2022

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Ortho-rheumatology: A new horizon to flourish orthopaedic practice p. 1
Sanjay Keshkar
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Distal humerus extraarticular fractures with large butterfly fragment: How we deal with it p. 3
Rajesh Kar, Sanjay Kumar, Anant Kumar Garg
Background: The treatment of distal-third extra-articular fracture of the humerus with large butterfly fragment is challenging and often controversial. The aim of this study is to see the result of open reduction and internal fixation of such fractures fixed with pre-contoured extra-articular anatomical locking plate in context to percentage of union, time of union and functional capability. Materials and Methods: This is a prospective study comprising of 28 cases from 2016 to 2019 with average follow-up of 19 months. In this study, all the cases included were extra-articular fractures of distal humerus having large butterfly fragments and were comminuted. The simple distal humeral extra-articular fractures without comminution were excluded from study. All the patients were operated on with posterior triceps reflecting approach and fixing the fractures with 3.5 mm pre-contoured extra-articular locking plate. Results: Out of 28 cases, there were 17 males and 11 females with mean age of 34.8 years. 4 patients were having post injury radial nerve palsy. None of the patients in our series were treated conservatively. The average time of operation after injury was 7 days and the average time of union was 20 weeks. 3 of the patients post operatively developed radial nerve palsy which completely recovered within 5 months. The results were evaluated with Mayo elbow performance score. Conclusion: Distal humeral comminuted extra-articular fractures are complex and difficult to manage. A pre-contoured distal humeral plate is a good option and gives adequate purchase for distal fixation. Moreover, the triceps sparing approach is good and chances of nerve injury and stiffness are less. We are happy with this plate and type of fixation.
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Evaluation of daily anti-tubercular treatment in osteoarticular tuberculosis p. 8
Lakhwani Omprakash
Background: Management of osteoarticular tuberculosis is primarily based on pulmonary tuberculosis guidelines. Guidelines usually do not take into consideration specific organ system affection, though tube pathology and healing of affected organ is not the same. Therefore, routine guidelines are difficult to follow in osteoarticular tuberculosis and many treatment regimes are in vague. Therefore, routine tuberculosis (TB) treatment is not followed, and many regimes are in vague. The current study is undertaken to objectively evaluate daily drug regime in osteoarticular TB and has specific guidelines. Materials and Methods: Drug-sensitive osteoarticular TB cases were evaluated for daily anti-tubercular treatment (ATT) guided by clinical and radiological healing. Patients were categorized based on stage, severity, and site of infection. Vitamin C and iron were also included in the daily treatment regime. Ethambutol was included in the continuation phase. Outcomes in terms of radiological healing and duration of daily regimen were studied. Results: All patients at 6 months of daily ATT showed clinical improvement but persistent disease on imaging. On magnetic resonance imaging, 16 out of 52 patients showed worsening at 6 months. Earliest healing appeared at 8 months. Healing appears to be faster in surgically treated patients. There was no relapse till the shortest follow-up of 2 years. Conclusion: The directly observed treatment strategy (DOTS), three times a week, is enough in osteoarticular TB. Daily drug with a minimum duration of 9 months is necessary. Diagnosis is usually delayed due to deep-seated infections, hence advance diagnosis modalities and high index of suspicion help. The study does not encounter any case of drug resistance. Addition of vitamin C appears to increase effectiveness of drugs. Duration of ATT should be determined by the pre-treatment disease activity and response to ATT.
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Functional outcome of open reduction and internal fixation of intra-articular distal radial fractures by volar locking plate p. 15
Upendra Kumar
Background: Intra-articular fracture of the distal end of the radius can be treated by various methods. The purpose of this study is to evaluate the functional outcomes of open reduction and internal fixation (ORIF) by volar locking plate (VLP) of intra-articular distal radial fractures. Materials and Methods: This is a single centre retrospective study conducted from April 2017 to May 2019 on adult patients having intra-articular distal radius fractures, who were treated by ORIF with VLP. As per medical records, the number of such patients for the study was 12. The fractures were classified as per the Frykman classification system. After operation, patients were followed up for a minimum of 24 weeks. Functional evaluation of the patients was done at the last follow-up according to the demerit point system of Gartland and Werley. Results: Twelve adult patients of intra-articular distal radius fractures were analysed retrospectively for functional outcomes of ORIF with VLP. The age ranged from 22 to 54 years, and males outnumbered females by a ratio of 2:1. The commonest mode of injury was found to be road traffic accidents (75%). The fractures were classified as per the Frykman classification system. Type III was the most common (50%), followed by Type IV (25%). The majority of the cases (58.3%) were operated in 2–5 days following injury. The mean time for union was 8 weeks. Functionally 11 (91.3%) patients had satisfactory (excellent + good) result at the final follow-up. Conclusion: ORIF with volar locking plate is a reliable, efficient, and rewarding procedure for intra-articular fracture of distal radius as it allows stable fixation with restoration of anatomy and function.
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Purposive bone shortening––a technique which aided soft-tissue coverage in a Grade III Gustillo–Anderson Open Distal Third Leg Fracture: A case report and treatment strategy p. 19
Mohamed Nazir Ashik, JK Giriraj Harshavardhan, S Sundar Suriyakumar
Problems faced in open fractures of the distal third tibia are usually associated with soft-tissue coverage, infection control, and union of the bone. Tibia is commonly associated with impaired healing if soft tissues are severely damaged. Not all cases can be treated with flaps due to its unavailability in acute settings, high learning curve, and cost. We present the outcomes of a case of an open Grade III-B Gustillo–Anderson distal tibia fracture treated with debridement and deliberate bony shortening which helped in primary closure of the wound. A 61-year-old gentleman, a known hypothyroid, had an alleged history of accidental cut injury over right lower limb by a machine used for cutting trees. He sustained a 7 cm × 4 cm laceration over the anteromedial aspect of the distal tibia with blown-out soft tissues and bone exposed. Wound debridement and stabilization with ankle spanning external fixation were immediately done. Wound could be primarily closed because the tibia and fibula were deliberately shortened during the external fixation. Many free bone fragments were removed during debridement leaving a bony void. One week later bone graft was used to fill the void after redebridement of the wound and wound could be primarily closed. Negative wound therapy was used as an adjuvant. One month later the external fixator was converted to Ilizarov fixator, which was removed at the end of 5 months, showing a fully healed fracture without soft-tissue complications at the end of 6 months follow-up. Debridement and shortening of the open tibia is a powerful technique to provide bony apposition and allow primary wound closure without tension, averting the need for any secondary reconstructive procedures.
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Management of hip dislocation following DHS fixation: A rare case report p. 24
Nabarun Saha, Amarendra Nath Roy, Anant Kumar Garg, Sunit Hazra, Sanjay Kumar
Dynamic hip screw (DHS) is an excellent implant for fixation of intertrochanteric fracture which helps the fracture components to slide together and impact, thus converting shearing force to compressive force. However, increased bending load over medial femoral cortex, excessive collapse at the fracture site, and unwanted rotation of proximal fragment lead to some cases of failure. Dislocation of hip following DHS fixation is the rarest of rare complications and probably not reported in literatures. We present one such case managed by two-staged total hip replacement using stability-range of motion prosthesis.
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Our Legends: Prof. K.S. Bose p. 27
Sanjay Keshkar, Dilip Kumar Mazumder, Samir Kumar Mukherjee
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