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   Table of Contents - Current issue
January-April 2022
Volume 37 | Issue 1
Page Nos. 1-36

Online since Friday, May 13, 2022

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Medical jousting in orthopedics p. 1
Kumar Keshav
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Prospective study of osteosynthesis with fibular bone grafting and hip screw fixation for late femoral neck fracture in young adults p. 3
Vinit Pathak, Javed Bhatti, Radha Kant Goyal, Imran Sajid
Background: Intracapsular fracture neck femur has always presented great challenges to orthopedic surgeons and still it continues to be a burning problem; thus, it is often called as an unsolved fracture. The femoral neck fracture is probably the fracture for which there exists the largest number of methods of osteosynthesis. We came into the world under brim of pelvis And go out through the Neck of Femur. The above quotation reflects the defeatist attitude that has long been held by medical and lay personal toward femoral neck fractures. Materials and Methods: The study was conducted in F.H. Medical College and Hospital, Agra. The cases of this study were selected from the patients attending the outpatient Department of Orthopaedics and from those arriving at the Emergency Department of F.H. Medical College and Hospital, Agra from November 2017 to December 2020. A total of 64 young adults with femoral neck fracture treated by a fibular bone graft with hip screw fixation were included in the study. All the fractures were more than 3 weeks old. Each patient was subjected to detailed clinical and radiological examination along with routine pathological investigations. Result: Results were assessed in 60 patients, whereas 4 patients were excluded from the study due to loss of follow-up. In the subcapital type, 33.3% of cases were found to have good score, 44.4% of cases had fair score, and rest of the cases were found to have poor score. In the transcervical type, 57.4% of cases scored good, 36.1% cases scored fair, and rest of the cases scored poor. In the basal type, 100% of cases were found to have good score. Therefore, transcervical and basal types of fractures have a good prognosis as compared with the subcapital type. The average follow-up was 16.4 months. Out of 60 patients assessed clinico-radiologically. Conclusion: We conclude that treatment of late femoral neck fracture is a simple and cost-effective procedure in young adults with good results.
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A randomized controlled trial between autologous platelet-rich plasma injection and corticosteroid injection in the treatment of plantar fasciitis p. 6
Pankaj Varshney, Ajeet Kumar Verma, Saumya Agarwal, Shivank Prakash, Pragya Garg, Prachi Agrawal
Background: Plantar fasciitis is the most common cause of chronic pain beneath the heel in adults, which may cause significant discomfort and disability. Local corticosteroid injections are a popular method of treating the condition but only seem to be useful in the short term and only to a small degree. Autologous platelet-rich plasma (PRP) is rich in growth factor, which stimulates reparative process unlike corticosteroids. Materials and Methods: A total of 30 patients were allocated in each group. Group A consisted of patients who received single 2 ml local corticosteroid injection, that is 80 mg methylprednisolone acetate, and group B consisted of patients who received single 3 cc autologous PRP injection locally. Results: The postinjection mean Foot and Ankle Ability Measure (FAAM) score was significantly higher at 4 weeks, 8 weeks, and 12 weeks in the steroid group as compared to that in the PRP group, but at 24 weeks, the mean FAAM score was significantly higher in the PRP group as compared to that in the steroid group. This shows that the maximum effect of PRP on the FAAM score was at 24 weeks, whereas in the steroid group, it was at 12 weeks. Also the maximum effect of PRP on Visual Analog Scale was at 24 weeks, whereas in the steroid group, it was at 12 weeks. There was 39.21% reduction in mean plantar fascia thickness in the steroid group and 43.27% reduction in the PRP group. Conclusion: Autologous PRP therapy is better than local corticosteroid injection in the long-term effect.
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Palmaris longus tendon for distal radio-ulnar ligament reconstruction – A novel technique p. 13
Amitabh Mohan, R Nagamahendran, Sanjay Singh, R Shankaran
Isolated Distal Radioulnar Joint (DRUJ) Instability is a rare phenomenon. It is usually associated with fractures of either the radius or ulna, and the treatment is not uniform. We present the case of a traumatic DRUJ instability presented to our centre with complaints of abnormal clicking sound in wrist during rotatory movements. During surgery, the stabilization of DRUJ was done using distal radioulnar ligament. Postoperative radiography showed proper alignment, with good stability of DRUJ.Correction of DRUJ instability is facilitated by distal radioulnar ligament reconstruction. The treatment is found to be effective with good outcome as compared to the conservative management and other surgical modalities widely practiced.
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Combination of Galeazzi fracture, fracture ulnar head, and ipsilateral posterior elbow dislocation: A rare case report p. 15
Mohammad Jesan Khan, Ariz Raza, Ujjawal Singhal, Sidra Asif
Posterior elbow dislocation, ipsilateral Galeazzi fracture, and fracture of ulnar head is a very unusual injury pattern. In the literature, only eight such cases have been reported. Another such case of a 24-year-old woman is being reported by us. Elbow dislocation was reduced immediately under sedation in an emergency. Radius was fixed with a compression plate and distal ulna was fixed with a K wire. Elbow and wrist physiotherapy is started 3 weeks after immobilization.
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Role of needle aponeurotomy and buddy taping as a natural continuous passive mobilization machine in Dupuytren’s contracture p. 18
Hitesh Lal, Jaswant Kumar, Rakesh Goyal, Nitin Mehta
Purpose: Needle aponeurotomy (NA) for Dupuytren’s contracture is gaining popularity and is becoming the standard primary treatment. We present a short series of patients with Dupuytren’s contracture managed by NA and elucidate the augmenting role of buddy taping as a natural anatomic continuous passive motion machine in maintaining the improvement in DASH (Disabilities of the Arm, Shoulder and Hand) scores. Materials and Methods: Four patients (five hands) with Dupuytren’s contracture all of whom were diabetic are included in the short case series. All patients had their contracture released by NA and the operated finger was buddy taped to adjacent finger. Results: The mean age of the patients was 48.75 years. Out of four patients, three had unilateral involvement and one had bilateral involvement of ring finger. The mean flexion contracture at the metacarpophalangeal (MCP) joint was 61°(50°–70°), whereas at PIP joint it was 36° (30°–40°) which improved to mean of 0° and 2° immediately after release and 0° and <5°, respectively, at the final follow-up. The mean DASH score improved from 16.25 to 3.77 at the final follow-up. We did not encounter any neurovascular injury in any of our patients related to the procedure though one patient complained of tingling sensation in all fingers and one patient had 1–2 mm of skin rupture. There was no relapse and no patient required secondary release. Conclusion: Patients with Dupuytren’s contracture released by NA have good clinical results. The mobilization of the taped buddy finger allows early, superior, cost-efficient rehabilitation and prevents relapse. Type of Study/Level of Evidence: Therapeutic IV
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Bilateral anterior shoulder dislocation following seizures in eclampsia p. 23
Mohammad Jesan Khan, Ujjawal Singhal, Mohd Hadi Aziz, Sidra Asif
Pain in the shoulders following seizure episodes should raise suspicion of a shoulder dislocation. As these injuries can be missed very easily in an unconscious patient, thorough clinical examination is of paramount importance in such cases. This is a case report of a 26-year-old female patient diagnosed as a case of bilateral anterior shoulder dislocation secondary to seizures as a complication of eclampsia. Patient was managed by closed reduction under anesthesia and reduction was performed successfully. A case report is mentioned in the literature about unilateral shoulder dislocation following seizures in eclampsia but to the best of our knowledge, no such case is mentioned about bilateral shoulder dislocation.
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Atypical fixation failure after the internal fixation of a peri-implant subtrochanteric fracture in a patient on long-term bisphosphonate therapy and its management: An interesting case report p. 26
Arulkumar Nallakumarasamy, Rajkumar Arya, Shivam Sinha, Rahul Yadav
Bisphosphonate therapy should be properly monitored in the treatment of osteoporosis, since it affects the bone turnover and may cause fatigue fractures. A new clinical adverse outcome due to long-term bisphosphonate therapy specifically in a postoperative osteoporotic patient is peri-implant fractures that are rarely described in the literature. Our case report describes an untoward biomechanical failure in the fixation of a peri-implant subtrochanteric fracture in an osteoporotic patient who is on long-term alendronate therapy and had been operated previously with dynamic hip screw and its management with 1-year follow-up.
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Fractures of all metacarpals of both hands: A rare case report p. 30
Atin Jaiswal, Vineet Agarwal, Shivendra Srivastava, Yashwant Singh Tanwar
Metacarpal bones are key structure elements in the anatomy of hand. Fractures of all the metacarpals of both hands have not been described in the literature. Malunited metacarpal fracture in a young male may be quite disabling, compromising hand functions. We present a case of compound fracture of all metacarpals of both hands in a 30-year-old man and its management with good functional outcome.
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Bilateral ankle arthrodesis with retrograde interlocking nail in charcot arthropathy of bilateral ankle joint p. 34
Mohammad Jesan Khan, Mohd Hadi Aziz, Ariz Raza, Sidra Asif
Despite technological breakthroughs in treatment techniques, definitive surgical treatment of Charcot’s arthropathy remains a difficulty. Several techniques for achieving stable ankle joint arthrodesis have been proposed. In recent research, deformity correction and arthrodesis with internal fixation have shown encouraging results. In this case report, we have described a case of severe destruction of both ankle joints treated by arthrodesis with a retrograde interlocking nail. Bilateral ankle arthrodesis in end-stage arthritis of the ankle joint is rare to find. This study addresses the proper surgical management in terms of approach and usage of appropriate implants to improve the long-term functional outcome when dealing with end-stage arthritis of the ankle joint.
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