Current Strategy of Management of Distal Radius Fractures in Geriatric Populations

Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 72-74 | Parag B Lad

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.606


Authors: Parag B Lad [1, 2]

[1] Department of Hand & Reconstructive Microsurgery, Pinnacle Orthocentre, Thane, Maharashtra, India,
[2] Department of Orthopaedics, Jupiter Hospital, Thane, Maharashtra, India.

Address of Correspondence
Dr. Parag B Lad,
Pinnacle Orthocentre, 1st floor, Blue Nile, Almeda Road, Thane, Maharashtra, India India, Jupiter Hospital.
E-mail: orthodoc_p@yahoo.com


Abstract

The distal radius fractures in geriatric population is one of common emergency admission in hospitals. In view of increasing life expectancy, requirement of continuation of work for having independent life, expectation of better outcome in active elderly population is changed. Non-operatively treated undisplaced and extra-articular fractures give good functional outcome. Intra-articular fractures or grossly displaced fractures in active geriatric patients are treated by open reduction and volar locking plate osteosynthesis. This article described factors to consider for treatment, methodology of treatment for various fracture patterns depending upon physical fitness of patient and radiological parameters.
Keywords: distal radius, geriatric, management


References

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8. Arora R, Gabl M, Erhart S, Schmidle G, Dallapozza C, Lutz M. Aspects of current management of distal radius fractures in the elderly individuals. Geriatr Orthop Surg Rehabil 2011;2:187-94.
9. Chung KC, Shauver MJ, Yin H, Kim HM, Baser O, Birkmeyer JD. Variations in the use of internal fixation for distal radial fracture in the United States medicare population. J Bone Joint Surg Am 2011;93:2154-62.
10. Walsh A, Merchan N, Bernstein DN, Ingalls B, Harper CM, Rozental TD. Predictors of management of distal radius fractures in patients aged >65 years. Hand (N Y) 2022;17:25S-30.
11. Tulipan JE, Lechtig A, Rozental TD, Harper CM. “Age is just a number”: Distal radius fractures in patients over 75. Hand (N Y) 2022;17:128-33.
12. Cooper AM, Wood TR, Scholten Ii DJ, Carroll EA. Nonsurgical management of distal radius fractures in the elderly: Approaches, risks and limitations. Orthop Res Rev 2022;14:287-92.
13. Kim KH, Duell B, Munnangi S, Long M, Morrison E. Radiographic predictors of delayed carpal tunnel syndrome after distal radius fracture in the elderly. Hand (N Y) 2022;17:652-8.
14. Gutiérrez-Espinoza H, Araya-Quintanilla F, Olguín-Huerta C, Gutiérrez-Monclus R, Valenzuela-Fuenzalida J, Román-Veas J, et al. Effectiveness of surgical versus conservative treatment of distal radius fractures in elderly patients: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2022;108:103323.
15. Olech J, Kopczyński B, Tomczyk Ł, Konieczny G, Kazubski K, Morasiewicz P. The functional and radiographic outcomes following distal radius fracture treatment in a cast for 4 and 6 weeks in the elderly: A randomized trial. Adv Clin Exp Med 2022;31:701-6.

How to Cite this article: Lad PB. Current Strategy of Management of Distal Radius Fractures in Geriatric Populations. Journal of Clinical Orthopaedics 2023;8(2):72-74.

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Delayed Onset Iatrogenic Femur fracture in a Child Primarily treated with Cerclage Wires: Unrecorded Complications of an Unconventional Treatment Method

Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 91-93 | Amol Gharote, N S Laud, Bhavika Mehta, Ashok Shyam

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.616


Authors: Amol Gharote [1], N S Laud [2], Bhavika Mehta [3], Ashok Shyam [3]

[1] Gharote Clinic, Thane Maharashtra, India.
[2] Laud Clinic, Dadar, Mumbai, Maharashtra, India.
[3] Sancheti Institute for Orthopaedics & Rehabilitation, Pune, Maharashtra, India.

Address of Correspondence
Dr. Bhavika Mehta
Sancheti Institute for Orthopaedics & Rehabilitation, Pune, Maharashtra, India..
E-mail: mehtabolismforyou@gmail.com


Abstract

Paediatric femur shaft fractures are common bony injuries in children. Although there are set protocol for these fractures, sometimes a deviation from standard methods may lead to unpredicted consequences. We report a case of femoral shaft fracture in a 8 years old boy which was primarily treated with 3 cerclage wires. The fracture healed over next few months but the child presented with refracture at the same site 11 months post first surgery. There was vascular compromise at the cerclage site which caused the fracture. This was treated with plate fixation and fracture finally healed. In this case report we highlight how not following the basic principles of treatment and management can lead to further complications. We also bring to light a previously unreported complication of one such unfavoured and rather unconventional method of fixation.
Keywords: Pediatric Femur Fracture, Cerclage, Nonunion, iatrogenic


References

  1. Rockwood and Wilkins’ Fracture in Children, 9th Edition (2020) Wolters Kluwer, China (Chapter 24-Page 1458).
  2. Duffy S, Gelfer Y, Trompeter A, Clarke A, Monsell F. The clinical features, management options and complications of paediatric femoral fractures. Eur J Orthop Surg Traumatol. 2021Jul;31(5):883-892.
  3. Liau GZQ, Lin HY, Wang Y, Nistala KRY, Cheong CK, Hui JHP. Pediatric Femoral Shaft Fracture: An Age-Based Treatment Algorithm. Indian J Orthop. 2020 Oct 10;55(1):55-67.
  4. P. NIEMEYER and N. P. SÜDKAMP, “Principles and Clinical Application of the Locking Compression Plate (LCP),” ACTA CHIRURGIAE ORTHOPAEDICAE ET TRAUMATOLOGIAE ČECHOSL., p. 221–228, 2006.
  5. Wallace ME, Hoffman EB. Remodelling of angular deformity after femoral shaft fractures in children. J Bone Joint Surg Br. 1992Sep;74(5):765-9.
  6. John R, Sharma S, Raj GN, Singh J, C V, Rhh A, Khurana A. Current Concepts in Paediatric Femoral Shaft Fractures. Open Orthop J. 2017 Apr 28;11:353-368.
  7. G. Harasen, “Orthopedic hardware and equipment for the beginner: Part 1. Pins and wires,” Orthopedics Orthopédie, vol. 52, no. -, pp. 1025-1026, 2011.
  8. M. van Steijn and J. Verhaar, “Osteonecrosis caused by percutaneous cerclage wiring of a tibial fracture: Case report,” Journal of Trauma, Injury, Infection, and Critical Care, vol. Volume 43 , no. 3 , pp. 521- 522 , 1997.
  9. P.Croniera, G.Pietub, C.Dujardinc, N.Bigorrea, F.Ducelliera and R.Gerardd, “The concept of locking plates,” Orthopaedics & Traumatology: Surgery & Research, vol. 96, no. 4, pp. S17-S36, 2010.
  10. C. Y. Lo, T. H. Lui and Y. K. Sit, “Split Fracture: A Complication of Cerclage Wiring of Acute Patellar Fracture,” Archives of Trauma Research, vol. 3, 2014.

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How to Cite this article: Gharote A, Laud NS, Mehta B, Shyam A. Delayed Onset Iatrogenic Femur fracture in a Child Primarily treated with Cerclage Wires: Unrecorded Complications of an Unconventional Treatment Method. Journal of Clinical Orthopaedics 2023;8(2):91-93.

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Treatment of Severe Genu Valgum Deformity Secondary to Renal Osteodystrophy by Medial Close Wedge Osteotomy using an Innovative Trigonometric Technique of Wedge Calculation

Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 85-87 | Vaibhav Sahu, Gaurav Garg

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.612


Author: Vaibhav Sahu [1], Gaurav Garg [1]

[1] Department of Orthopedics, ESI-PGIMSR, New Delhi, India

Address of Correspondence

Dr. Gaurav Garg,

Department of Orthopedics, ESI-PGIMSR, New Delhi – 110 015, India.

E-mail: gauravgarg9999@gmail.com


Abstract

Genu valgum is one of the most common deformity of the knee in which the knee bend toward the midline with increase in the intermalleolar distance. It is often treated surgically with the osteotomy or by growth modulation techniques such as hemiepiphysiodesis using bone staplers. We, hereby, present a case of 16-year-old female with severe genu valgum deformity of bilateral lower limbs secondary to renal osteodystrophy causing pain in her bilateral lower limbs and inability to walk. She was treated by McEwan’s close wedge osteotomy using an innovative trigonometric-based technique for calculation of wedge size which resulted in accurate correction of deformity.
Keywords: Genu valgum, Renal osteodystrophy, Medial close wedge osteotomy, Trigonometric method of wedge calculation.


References

1. McEwan W. Lecture on antiseptic osteotomy for genu valgum, genu varum, and other osseous deformities. Lancet 1878;112:911-4.
2. Wesseling-Perry K, Salusky IB. Chronic kidney disease: Mineral and bone disorder in children. Seminars in Nephrology 2013;33:169-79.
3. Niki H, Aoki H, Hirano T, Beppu M. Severe genu valgum deformity and slipped capital femoral epiphysis with renal osteodystrophy: A report of two cases. J Orthop Sci 2012;17:500-6.
4. Oppenheim WL, Fischer SR, Salusky IB. Surgical correction of angular deformity of the knee in children with renal osteodystrophy. J Pediatr Orthop 1997;17:41-9.
5. Davids JR, Fisher R, Lum G, Von Glinski S. Angular deformity of the lower extremity in children with renal osteodystrophy. J Pediatr Orthop 1992;12:291-9.
6. Bauer GC, Insall J, Koshino T. Tibial osteotomy in gonarthrosis (osteo arthritis of the knee). J Bone Joint Surg Am 1969;51:1545-63.
7. Filho EL, Torres MR, Silva MR, Lima FR, Anguir JL. Simplified calculation for corrective osteotomies of long bones. Acta Orthop Bras 2016;24:253-8.
8. Warnock KM, Johnson BD, Wright JB, Ambrose CG, Clanton TO, McGarvey WC. Calculation of the opening wedge for a low tibial osteotomy. Foot Ankle Int 2004;25:778-82.
9. Wylie JD, Maak TG. Medial closing-wedge distal femoral osteotomy for genu valgum with lateral compartment disease. Arthrosc Tech 2016;5:e1357-66.

 

How to Cite this article: Sahu V, Garg G. Treatment of Severe Genu Valgum Deformity Secondary to Renal Osteodystrophy by Medial Close Wedge Osteotomy using an Innovative Trigonometric Technique of Wedge Calculation. Journal of Clinical Orthopaedics Jul-Dec 2023;8(2):85-87.

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Challenges Faced in the Surgical Fixation of a 4 Part Inter-Trochanteric Fracture in a Patient with Ipsilateral Below Knee Amputation and Uncontrolled Diabetes Mellitus

Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 88-90 | Ameya Haritosh Velankar, Sanjeev Singh, Ashok Ghodke, Deepak Jain, Aditya More, Kriteya Singh

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.614


Authors: Ameya Haritosh Velankar [1] Sanjeev Singh [1], Ashok Ghodke [1], Deepak Jain [1], Aditya More [1], Kriteya Singh [1]

[1] Department of Orthopaedics, MGM Institute of Health Sciences, Kamothe, Navi-Mumbai- 410209, Maharashtra, India.

Address of Correspondence
Dr. Deepak Jain,
Department of Orthopaedics, MGM Institute of Health Sciences, Kamothe, Navi-Mumbai- 410209, Maharashtra, India.
Email: deepaksjain1993@gmail.com


Abstract

Operative treatment of hip fractures in a patient with below-knee amputation on the same extremity poses a great challenge in terms of obtaining an optimal amount of traction for fracture reduction. The absence of the foot and the distal lower limb which makes the positioning difficult and other medical co-morbidities contribute to the same. We present a case report of a 66-year-old man with ipsilateral below-knee amputation who underwent surgical fixation of a comminuted 4-part right intertrochanteric femur fracture. We discuss the pros and cons of various methods and highlight a simple and effective technique of reverse boot traction for fracture reduction.

Keywords: Inter trochanteric fracture, 4-part fracture, amputation, diabetes mellitus, reverse boot.


References

  1. Gamulin A, Farshad M. Amputated lower limb fixation to the fracture table. Orthopedics 2015;38:679-82.
  2. Gamulin A, Farshad M. Intertrochanteric femur fracture fixation in a patient with below knee amputation presents a surgical dilemma: A case report. Orthopedics 2015;38:679-82.
  3. Lee BH, Ho SW, Kau CY. Surgical fixation of a comminuted inter-trochanteric fracture in a patient with bilateral below knee amputation. Malays Orthop J 2018;12:54-6.
  4. Rethnam U, Yesupalan RS, Shoaib A, Ratnam TK. Hip fracture fixation in a patient with below-knee amputation presents a surgical dilemma: A case report. J Med Case Rep 2008;2:296.
  5. Nagesh H, Bhargava A, Brooks C. Reverse boot traction-a simple technique for operative management of trochanteric fractures in patients with ipsilateral below knee amputation. Orthop Proc 2004;86:82.

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How to Cite this article: Velankar AH, Singh S, Jain D, Ghodke A, More A, Singh K. Challenges Faced in
the Surgical Fixation of a 4 Part Inter-Trochanteric Femur Fracture in a Patient with Ipsilateral Below Knee Amputation and Uncontrolled Diabetes Mellitus. Journal of Clinical Orthopaedics 2023;8(2):88-90.

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The Efficacy of High Tibial Osteotomy with or without Post-root Medial Meniscus Repair: A Systematic Review

Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 80-84 | Aishwarya Roy, Kiran Kumari, Miten Sheth

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.610


Authors: Aishwarya Roy [1], Kiran Kumari [2], Miten Sheth [1]

[1] Third Year Junior Resident in Seth GS Medical College & KEM Hospital, Mumbai, India,

[2] Postgraduate student, Msc Public Health, University of Bristol, United Kingdom.

Address of Correspondence
Dr. Aishwarya Roy,
16/2 P. majumder Road Kolkata -700078, India.
E-mail: ash46roy@gmail.com


Abstract

Background: High tibial osteotomy (HTO) is a knee joint treatment modality for medial compartment arthritis, aiming to improve articular cartilage healing by shifting the lower limb’s axis. It is commonly used in younger patients with pain and active lifestyles, preventing advanced cartilage deterioration. Varus malalignment may often be accompanied with medial meniscus root tears. In recent years, meniscus root tears are often been repaired. However, the efficacy of medial meniscus repairs with high tibial in varus malalignment with medial meniscal tears remains a controversy.
Purpose: The purpose is to study the functional outcomes of concurrent medial meniscus root repair with HTO versus HTO alone.
Study design: Systematic review.
Methods: According to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, we searched PubMed, Embase, Web of Science, and the Cochrane Library databases for studies reporting the outcomes of medial meniscus posterior root tear (MMPRT) repair with HTO versus HTO alone and extracted data about characteristics of patients, clinical functional scores, and radiologic outcomes. One reviewer extracted data and 1 reviewer assessed the risk of bias and performed a synthesis of the evidence. Articles were eligible if they reported the functional outcome of HTO alone or HTO and MMPRT repair in patients of varus malalignment and medial meniscus root tears.
Results: 6 studies with 264 patients were identified. Data from these studies were segregated in HTO only and HTO with medial meniscus repair group. The findings of this systematic review suggest that the outcomes of HTO with MMPHRR and of only HTO are not statistically significant, meaning that doing valgus osteotomy only in patients with varus knee and MMPHRT can give good results regardless of not repairing the meniscus.
Conclusion: HTO with medial meniscus posterior horn root repair seems to have no significant improvement in the functional outcomes of the patient. However, long-term studies need to be performed.
Keywords: High tibial osteotomy, medial meniscus, root repair, arthroscopy, varus malalignment, meniscus, root tear


References

1. Ke, Xiurong et al. “Concurrent arthroscopic meniscal repair during open-wedge high tibial osteotomy is not clinically beneficial for medial meniscus posterior root tears.” Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA vol. 29,3 (2021): 955-965. doi:10.1007/s00167-020-06055-9
2. Lee, Dhong Won et al. “Outcomes of Medial Meniscal Posterior Root Repair During Proximal Tibial Osteotomy: Is Root Repair Beneficial?.” Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association vol. 36,9 (2020): 2466-2475. doi:10.1016/j.arthro.2020.04.038
3. Jing, Lizhong et al. “Second-look arthroscopic findings after medial open-wedge high tibial osteotomy combined with all-inside repair of medial meniscus posterior root tears.” Journal of orthopaedic surgery (Hong Kong) vol. 28,1 (2020): 2309499019888836. doi:10.1177/2309499019888836
4. Suh, Dong Won et al. “Simple Medial Meniscus Posterior Horn Root Repair Using an All-Inside Meniscal Repair Device Combined with High Tibial Osteotomy to Maintain Joint-Space Width in a Patient with a Repairable Tear.” Indian journal of orthopaedics vol. 55,2 397-404. 31 Aug. 2020, doi:10.1007/s43465-020-00234-z
5. Kim YM, Joo YB, Lee WY, Kim YK. Remodified Mason-Allen suture technique concomitant with high tibial osteotomy for medial meniscus posterior root tears improved the healing of the repaired root and suppressed osteoarthritis progression. Knee Surg Sports Traumatol Arthrosc 2020;29:1258-68.
6. Omae, Hiroaki et al. “Arthroscopic pullout repair versus suture anchor repair for medial meniscus posterior root tear combined with high tibial osteotomy.” The Knee vol. 45 (2023): 117-127. doi:10.1016/j.knee.2023.10.011
7. Lee OS, Lee SH, Lee YS. Comparison of the radiologic, arthroscopic, and clinical outcomes between repaired versus unrepaired medial meniscus posterior horn root tear during open wedge high tibial osteotomy. J Knee Surg 2019;34:57-66.
8. Jing L, Liu K, Wang X, Wang X, Li Z, Zhang X, et al. Second-look arthroscopic findings after medial open-wedge high tibial osteotomy combined with all-inside repair of medial meniscus posterior root tears. J Orthop Surg (Hong Kong) 2019;28:230949901988883.
9. Ke X, Qiu J, Chen S, Sun X, Wu F, Yang G, et al. Concurrent arthroscopic meniscal repair during open-wedge high tibial osteotomy is not clinically beneficial for medial meniscus posterior root tears. Knee Surg Sports Traumatol Arthrosc 2020;29:955-645.
10. Kim KI, Bae JK, Jeon SW Kim GB. Medial meniscus posterior root tear does not affect the outcome of medial open-wedge high tibial osteotomy. J Arthroplasty 2021;36:423-8.
11. Omae H, Yanagisawa S, Hagiwara K, Ogoshi A, Omodaka T, Kimura M. Arthroscopic pullout repair versus suture anchor repair for medial meniscus posterior root tear combined with high tibial osteotomy. Knee 2023;45:117-27.
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13. Suh DW, Yeo WJ, Han SB, So SY, Kyung BS. Simple medial meniscus posterior horn root repair using an all-inside meniscal repair device combined with high tibial osteotomy to maintain joint-space width in a patient with a repairable tear. Indian J Orthop 2020;55:397-404.
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15. Lee OS, Ahn S, Lee YS. Effect and safety of early weight-bearing on the outcome after open-wedge high tibial osteotomy: A systematic review and meta-analysis. Arch Orthop Trauma Surg 2017;137:903-11.

How to Cite this article: Roy A, Kumari K. The Efficacy of High Tibial Osteotomy with or without Post-root Medial Meniscus Repair: A Systematic Review. Journal of Clinical Orthopaedics 2023;8(2):80-84.

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Newer Coronal Alignment Philosophies in Total Knee Arthroplasty: A Brief Review

Journal of Clinical Orthopaedics | Vol 8 | Issue 2 |  Jul-Dec 2023 | page: 75-79 | Anoop C Dhamangaonkar

DOI: https://doi.org/10.13107/jcorth.2023.v08i02.608


Authors: Anoop C Dhamangaonkar [1, 2]

[1] Adult Joint Reconstruction Surgeon, ORTHOPOD Speciality Clinic, Mumbai, Maharashtra-400 001, India.

Address of Correspondence
Dr. Anoop C Dhamangaonkar,
Adult Joint Reconstruction Surgeon, ORTHOPOD Speciality Clinic, Mumbai, Maharashtra-400 001, India.
E-mail: anoopd_7@yahoo.com


Abstract

Total Knee Arthroplasty (TKA) surgeries have been one of the most successful surgeries over the past half a decade. However a substantial proportion of patients undergoing TKA have the feeling of their replaced knee being an ‘unnatural one’. Also the conventional TKA requires the surgeon to maintain a coronal plane Hip Knee Angle (HKA) of 180 deg with the joint line being parallel to the horizontal and this requires a significant soft tissue release. Recently there are many different pre arthritic knee phenotypes been described with varying joint line obliquities and HKA angles. It is this difference of coronal HKA axis and joint line obliquity in the non replaced and the replaced knee that is believed to be the cause of dissatisfaction after TKA. Many coronal plane alignment philosophies have been reported to bridge this gap as mentioned earlier which replicate the pre arthritic knee anatomy with minimal soft tissue release. The only concern of the different philosophies is the long term implant survival when fixed in a non mechanically aligned position. However robotics have added a significant safety with calibrated execution to prevent outliers and improve implant survivorship. This is a brief review of the different coronal plane alignment philosophies in TKA.

Keywords: Coronal, alignment, dissatisfaction, HKA, joint line obliquity


References

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How to Cite this article: Dhamangaonkar AC. Newer Coronal Alignment Philosophies in Total Knee Arthroplasty: A Brief Review. Journal of Clinical Orthopaedics 2023;8(2)75-79.

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