hi

/in /by

hi

Editorial 2023

/in /by

Journal of Clinical Orthopaedics | Vol 8 | Issue 1 |  Jan-Jun 2023 | page: 01 | Dr. Nicholas Antao, Dr. Ashok Shyam

DOI: 10.13107/jcorth.2022.v08i01.546

Author: Dr. Nicholas Antao [1], Dr. Ashok Shyam [2]

[1] Department of Orthopaedics, Hill Way Clinic, Hill N Dale Building, 4th Floor, Hill Road, Bandra West, Mumbai, Maharashtra, India.

[2] Department of Orthopaedics, Sancheti Institute for Orthopaedics and Rehablitation, Pune, India.

Address of Correspondence
Dr. Nicholas Antao,
Head of Department of Orthopaedics, Holy Spirit Hospital, Mahakali Road, Andheri (E), Mumbai – 400093, Maharashtra, India.
E-mail: narantao@gmail.com

Editorial 

Our last WIROC-22 issue was mainly on paediatrics articles from a well written, accepted and acclaimed symposium on “Office Orthopaedics in Paediatrics” This issue contains thought provoking articles that were not covered earlier in that symposium.

Whereas anterior knee pain in adults is quite complex, similar pain in the paediatrics age can be quite perplexing. A well written article here will help you to gather your thoughts and make precision diagnosis.
Any deformity in the child is quite disabling and depressing for the parent that they very keen to get treatment to correct the same as early as possible. Can you imagine the agony of the parent when their child has such a deformity congenital or acquired and they would be very keen to do everything on earth to free the child of the same? The role of braces is well discussed in this issue and will be very helpful in guiding them to avoid their fear.
Flat feet are a common entity often worrying the parent, that their ward is not walking properly, complaining about pain while walking, running or the shoes get worn out fast. The most information given in the article is to understand the difference between rigid flat feet and correctible flat feet and the associated tight tissues and joints to be notably corrected.
CTEV is a common congenital deformity of the feet and the evolution of Ponsetti’s method with Pirani’s score helps you to understand deeper into the problem and the knowledge how to correct the deformity through serial manipulation and plastering. The author has described the method very succinctly.
We all know how difficult is to get rid of pain of gouty arthritis with allopathic medicine and even surgical methods often do not give the desired results to make patient pain-free of the ailment. A multicentric study revealed that herbal therapy is more effective than allopathic therapy is very interesting and informative. Another multicentric review on non-operative treatment of early osteoarthrosis is interesting is indeed very interesting with Orthobiologics playing a major role in defining the its role and how effective it can be in the initial stages.
We are happy that this issue has multicentric study reviews which is very encouraging and the most important factor to take indexing of the journal to a higher level.
All of us are aware of how much the COVID took the toll of medical and para medics life, inter personal relationships, workplace issue and various other problems in the management of this pandemic. The article Burnout in COVID-19 residency highlighted the innumerable problems and issues the resident faced in tackling the pandemic. They concluded that the educators should consider pertinent instruction and interventions during the process of instructing resident doctors which is vital to save the life of the patient, resident, paramedics and better management of the patient and the burn out. An interesting, rare case report on giant cell tumor of the tendon sheath is very informative.

Finally, the article on prevention of sports injuries is an eye opener to counsel patients with sports injuries to prevent further deterioration of the injury.

 

Dr. Nicholas Antao,

Dr. Ashok Shyam.

How to Cite this article: Antao N, Shyam A. Editorial. Journal of Clinical Orthopaedics Jan-Jun 2023;8(1):01.

 

(Abstract    Full Text HTML)   (Download PDF)

Gout Arthritis Progression in Treatment with Herbal Therapy: A Systematic Review

/in /by

Journal of Clinical Orthopaedics | Vol 8 | Issue 1 |  Jan-Jun 2023 | page: 02-07 | I Putu Arya Agung Pratama, I Wayan Subawa

DOI: :10.13107/jcorth.2023.v08i01.547

Author: I Putu Arya Agung Pratama [1] I Wayan Subawa [2]

[1] Department of Orthopedics, General Practitioner, Faculty of Medicine Udayana University, Denpasar, Bali, Indonesia,
[2] Department of Orthopedics and Traumatology, General Hospital Prof. dr. IGNG Ngoerah, Faculty of Medicine Udayana University, Denpasar, Bali, Indonesia.

Address of Correspondence
Dr. I Putu Arya Agung Pratama,

Faculty of Medicine, Udayana University, Denpasar, Bali.

E-mail: aryaagungpratama@gmail.com

Abstract

Introduction: Gout is a common arthritis condition due to deposition of monosodium urate (MSU) and is closely related to hyperuricemia. The goal of gout treatment in the acute stage of gouty arthritis mainly focuses on relieving pain while slowing down or stopping progression and further gout flares in the chronic stage, ultimately improving joint function, and increasing the quality of life.

Materials and Methods: A literature search was carried out to determine potential studies for this review up to November 2022. The search was performed using the PubMed/MEDLINE, Cochrane Library, and Google Scholar databases including keywords that matched the MeSH rule and the term used for herbal therapy and gout arthritis.

Results: The search strategy generated several diverse literatures presenting a variety of randomized control trial of herbal therapy in gout arthritis patient. A total of eight studies were included in the review. Satisfactory pain relieve and decreasing of serum uric acid level were found in most of the studies. Decreasing of serum uric acid level statistically significantly found in six of the eight studies studied. Furthermore, significant fewer incident of adverse event found in four studies.

Conclusion: Herbal therapy or medication are potentially more effective than western medications or placebos at slowing the progression of pain, lowering blood uric acid levels, and preventing some adverse events in gout patients.

Keywords: Arthritis, gout, herbal therapy, progression, uric acid level.

References

  1. Chi X, Zhang H, Zhang S, Ma K. Chinese herbal medicine for gout: A review of the clinical evidence and pharmacological mechanisms. Chin Med 2020;15:17.
  2. Hwang JH, Song HS. External application of herbal medicine for gout: A protocol for systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021;100:e25649.
  3. Zhou L, Liu L, Liu X, Chen P, Liu L, Zhang Y, et al. Systematic review and meta-analysis of the clinical efficacy and adverse effects of Chinese herbal decoction for the treatment of gout. PLoS One 2014;9:e85008.
  4. Xiao YZ, Ye ZZ, Liang YT, Chen XP, Wang YH, Xu Q, et al. Association between Chinese herbal medicine therapy and the risk of chronic kidney disease in gout patients. Front Pharmacol 2021;12:661282.
  5. Fan Y, Liu W, Lu H, Liu J, Wu R, Zhao J, et al. Efficacy and safety of qinpi tongfeng formula in the treatment of acute gouty arthritis: A double-blind, double-dummy, multicenter, randomized controlled trial. Evid Based Complement Alternat Med 2022;2022:7873426.
  6. Chan E, House ME, Petrie KJ, Horne A, Taylor WJ, Dalbeth N. Complementary and alternative medicine use in patients with gout: A longitudinal observational study. J Clin Rheumatol 2014;20:16-20.
  7. Li H, Nie D, Wang S, Li D, Liu C. Clinical value of turbidity-elimination gout soup combined with external application of traditional Chinese medicine to improve the pain and the volume of tophi in patients with gout. Food Sci Technol 2022;42:37420.
  8. Shasha W, Ying Z, Min D, Min Y, Wenfei L, Xiufeng P, et al. Efficacy of rebixiao Chinese herbal tablets and Chinese formula granules in acute gout arthritis patients: A randomized, multicenter, double-blind, controlled trial. J Tradit Chin Med 2020;40:664-73.
  9. Wang YG, Wang L, Li EZ, Li Y, Wang ZC, Sun XF, et al. Chuanhu anti-gout mixture versus colchicine for acute gouty arthritis: A randomized, double-blind, double-dummy, non-inferiority trial. Int J Med Sci 2014;11:880-5.
  10. Yu XN, Wu HY, Deng YP, Zhuang GT, Tan BH, Huang YZ, et al. Yellow-dragon Wonderful-seed Formula” for hyperuricemia in gout patients with dampness-heat pouring downward pattern: A pilot randomized controlled trial. Trials 2018;19:551.
  11. Xie Z, Wu H, Jing X, Li X, Li Y, Han Y, et al. Hypouricemic and arthritis relapse-reducing effects of compound tufuling oral-liquid in intercritical and chronic gout: A double-blind, placebo-controlled, multicenter randomized trial. Medicine (Baltimore) 2017;96:e6315.
  12. Suntuko B, Hellmi RY, Vemilia I, Agung S. Randomized controlled trial of herbal extracts (Eugenia polyantha, Apium graveolens, Nigella sativa) and allopurinol effect on serum uric acid, urinary uric acid and high sensitivity C-reactive protein levelsin subject with hyperuricemia. Indones J Rheumatol 2019;11:191-9.
  13. Chen L, Luo Z, Wang M, Cheng J, Li F, Lu H, et al. The efficacy and mechanism of Chinese herbal medicines in lowering serum uric acid levels: A systematic review. Front Pharmacol 2021;11:578318.
  14. Li XX, Han M, Wang YY, Liu JP. Chinese herbal medicine for gout: A systematic review of randomized clinical trials. Clin Rheumatol 2013;32:943-59.

 

How to Cite this article: Pratama IPAA, Subawa IW. Gout Arthritis Progression in Treatment with Herbal Therapy: A Systematic Review. Journal of Clinical Orthopaedics Jan-Jun 2023;8(1):02-07.

 (Abstract    Full Text HTML)   (Download PDF)

Invasive Non-Arthroplasty Treatment Options for Knee Osteoarthritis: Review

/in /by

Journal of Clinical Orthopaedics | Vol 8 | Issue 1 |  Jan-Jun 2023 | page: 08-17 | Rohan G Reddy, YuChia Wang, Ryan Scully, Savyasachi C Thakkar

DOI: :10.13107/jcorth.2023.v08i01.549

Author: Rohan G Reddy [1], YuChia Wang [2], Ryan Scully [3], Savyasachi C Thakkar [4]

[1] Orthopaedic Research Collaborative (ORC); Johns Hopkins University, Baltimore, Maryland, United States, ,
[2] Orthopaedic Research Collaborative (ORC);Department of Orthopaedic Surgery, Eastern Virginia Medical School, Norfolk, Virginia, United States,
[3] Orthopaedic Research Collaborative (ORC); Department of Orthopaedic Surgery, Naval Hospital Camp Pendleton, Oceanside, California, United States,

[4] Orthopaedic Research Collaborative (ORC); Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland, United States.

Address of Correspondence
Dr. Rohan G Reddy,

Johns Hopkins University, Baltimore, Maryland, United States.

E-mail: rreddy19@jhu.edu

Abstract

Introduction: Knee osteoarthritis (KOA) is one of the most common joint diseases in the world, such that there exists a variety of treatment methods, ranging from conservative treatments such as physical therapy and weight loss to total replacement of the diseased joint. Invasive non-arthroplasty treatment methods are growing in popularity and this review aims to explore the current literature. Better understanding of these alternatives could allow orthopedic surgeons and primary care providers to offer poor arthroplasty candidates meaningful symptomatic relief.

Materials and Methods: A literature review using PubMed, Google Scholar, and SCOPUS was performed to examine the following invasive non-arthroplasty treatment options: Corticosteroid injections (CS), viscosupplementation, platelet-rich plasma injections, stem cell injections, ozone therapy, prolotherapy, radiofrequency nerve ablation (RFA), arthroscopy, and osteotomy. Articles with complete data on the outcomes following these treatment methods were included in the study.

Results: CSs showed strong efficacy in providing short-term pain relief, while viscosupplementation and platelet-rich plasma have shown to be effective in long-term management as well. Aside from the more common injectable treatment options, newer options such as stem cell injection and ozone therapy have shown clinical efficacy while prolotherapy and RFA are still early-stage treatment options. Still, further studies are required to better assess these emerging therapies. Operatively, arthroscopic surgery has shown to be minimally effective while osteotomy demonstrated effective pain and functional improvement.

Conclusion: Multiple therapeutic options exist for invasive management of KOA to a different degree of effectiveness and efficacy. We have analyzed the outcomes of multiple invasive non-arthroplasty treatment options for KOA. This review can better inform patients and surgeons of the pros and cons of different KOA treatment methods. Newer conservative options may have positive clinical implications but will require further investigation. Operative alternatives to arthroplasty can provide symptomatic relief but may increase the associated risk and complexity should the need for arthroplasty ever arises.

Keywords: Total knee arthroplasty, injections, radiofrequency nerve ablation, arthroscopy, osteotomy.

References

  1. Zhang Y, Jordan JM. Epidemiology of osteoarthritis. Clin Geriatr Med 2010;26:355-69.
  2. Billesberger LM, Fisher KM, Qadri YJ, Boortz-Marx RL. Procedural treatments for knee osteoarthritis: A review of current injectable therapies. Pain Res Manag 2020;2020:3873098.
  3. Martin CL, Browne JA. Intra-articular corticosteroid injections for symptomatic knee osteoarthritis: What the orthopaedic provider needs to know. J Am Acad Orthop Surg 2019;27:e758-66.
  4. Kaplan DJ, Haskel JD, Kirby DJ, Bloom DA, Youm T. The simplified science of corticosteroids for clinicians. JBJS Rev2020;8:
  5. American Academy of Orthopaedic Surgeons. Management of Osteoarthritis of the Knee (Non-Arthroplasty) Evidence-Based Clinical Practice Guideline. 3rd United States: American Academy of Orthopaedic Surgeons; 2021. Available from: https://www.aaos.org/oak3cpg. Last accessed 25 Janurary 2023.
  6. Matzkin EG, Curry EJ, Kong Q, Rogers MJ, Henry M, Smith EL. Efficacy and treatment response of intra-articular corticosteroid injections in patients with symptomatic knee osteoarthritis. J Am Acad Orthop Surg2017;25:703-14.
  7. Najm A, Alunno A, Gwinnutt JM, Weill C, Berenbaum F. Efficacy of intra-articular corticosteroid injections in knee osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. Joint Bone Spine 2021;88:105198.
  8. WerneckeC, BraunHJ, DragooJL. The effect of intra-articular corticosteroids on articular cartilage: A systematic review. Orthop J Sports Med2015;3.
  9. McAlindon TE, LaValley MP, Harvey WF, Price LL, Driban JB, Zhang M, et al. Effect of intra-articular triamcinolone vs saline on knee cartilage volume and pain in patients with knee osteoarthritis: A randomized clinical trial. JAMA 2017;317:1967-75.
  10. Altman R, Hackel J, Niazi F, Shaw P, Nicholls M. Efficacy and safety of repeated courses of hyaluronic acid injections for knee osteoarthritis: A systematic review. Semin Arthritis Rheum 2018;48:168-75.
  11. Tang JZ, Nie MJ, Zhao JZ, Zhang GC, Zhang Q, Wang B. Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: A meta-analysis. J Orthop Surg Res 2020;15:403.
  12. Navarro-Sarabia F, Coronel P, Collantes E, Navarro FJ, de la Serna AR, Naranjo A, et al. A 40-month multicentre, randomised placebo-controlled study to assess the efficacy and carry-over effect of repeated intra-articular injections of hyaluronic acid in knee osteoarthritis: The AMELIA project. Ann rheum Dis 2011;70:1957-62.
  13. He W, Kuang M, Zhao J, Sun L, Lu B, Wang Y, et al. Efficacy and safety of intraarticular hyaluronic acid and corticosteroid for knee osteoarthritis: A meta-analysis. Int J Surg 2017;39:95-103.
  14. Smith C, Patel R, Vannabouathong C, Sales B, Rabinovich A, McCormack R, et al. Combined intra-articular injection of corticosteroid and hyaluronic acid reduces pain compared to hyaluronic acid alone in the treatment of knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2018;27:1974-83.
  15. Concoff A, Sancheti P, Niazi F, Shaw P, Rosen J. The efficacy of multiple versus single hyaluronic acid injections: A systematic review and meta-analysis. BMC Musculoskelet Disord2017;18:
  16. Tan J, Chen H, Zhao L, Huang W. Platelet-rich plasma versus hyaluronic acid in the treatment of knee osteoarthritis: A meta-analysis of 26 randomized controlled trials. Arthroscopy 2021;37:309-25.
  17. Richardson SS, Schairer WW, Sculco TP, Sculco PK. Comparison of infection risk with corticosteroid or hyaluronic acid injection prior to total knee arthroplasty. J Bone Joint Surg Am 2019;101:112-8.
  18. Peck J, Slovek A, Miro P, Vij N, Traube B, Lee C, et al. A comprehensive review of viscosupplementation in osteoarthritis of the knee. Orthop Rev (Pavia) 2021;13:25549.
  19. Sundman EA, Cole BJ, Karas V, Valle CD, Tetreault MW, Mohammed MO, et al. The anti-inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis. Am J Sports Med 2014;42:35-41.
  20. Buul G, Koevoet W, Kops N, Bos PK, Verhaar JA, Weinans H, et al. Platelet-rich plasma releasate inhibits inflammatory processes in osteoarthritic chondrocytes. Am J Sports Med 2011;39:2362-70.
  21. Hong M, Cheng C, Sun X, Yan Y, Zhang Q, Wang W, et al. Efficacy and safety of intra-articular platelet-rich plasma in osteoarthritis knee: A systematic review and meta-analysis. Biomed Res Int 2021;2021:2191926.
  22. Raeissadat SA, Rayegani SM, Hassanabadi H, Fathi M, Ghorbani E, Babaee M, et al. Knee osteoarthritis injection choices: Platelet- rich plasma (PRP) versus hyaluronic acid (A one-year randomized clinical trial). Clin Med Insights Arthritis Musculoskelet Disord 2015;2015:1-8.
  23. UsluGüvendi  E, Aşkin A, Güvendi G, Koçyiğit H. Comparison of efficiency between corticosteroid and platelet rich plasma injection therapies in patients with knee osteoarthritis. Arch Rheumatol2018;33:273-81.
  24. Shen L, Yuan T, Chen S, Xie X, Zhang C. The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: Systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res2017;12:
  25. McLarnon M, Heron N. Intra-articular platelet-rich plasma injections versus intra-articular corticosteroid injections for symptomatic management of knee osteoarthritis: Systematic review and meta-analysis. BMC Musculoskelet Disord 2021;22.
  26. Xu Z, He Z, Shu L, Li X, Ma M, Ye C. Intra-articular platelet-rich plasma combined with hyaluronic acid injection for knee osteoarthritis is superior to platelet-rich plasma or hyaluronic acid alone in inhibiting inflammation and improving pain and function. Arthroscopy 2021;37:903-15.
  27. Karasavvidis T, Totlis T, Gilat R, Cole BJ. Platelet-rich plasma combined with hyaluronic acid improves pain and function compared with hyaluronic acid alone in knee osteoarthritis: A systematic review and meta-analysis. Arthroscopy 2021;37:1277-87.e1.
  28. Aw AA, Leeu JJ, Tao X, Razak HR. Comparing the efficacy of dual platelet-rich plasma (PRP) and hyaluronic acid (HA) therapy with PRP-alone therapy in the treatment of knee osteoarthritis: A systematic review and meta-analysis. J Exp Orthop 2021;8:101.
  29. Piuzzi NS, Ng M, Kantor A, Ng K, Kha S, Mont MA, et al. What is the price and claimed efficacy of platelet-rich plasma injections for the treatment of knee osteoarthritis in the United States? J Knee Surg 2019;32:879-85.
  30. Lee JS, Shim DW, Kang KY, Chae DS, Lee WS. Method categorization of stem cell therapy for degenerative osteoarthritis of the knee: A review. Int J Mol Sci 2021;22.
  31. Song Y, Du H, Dai C, Zhang L, Li S, Hunter DJ, et al. Human adipose-derived mesenchymal stem cells for osteoarthritis: A pilot study with long-term follow-up and repeated injections. Regen Med 2018;13:295-307.
  32. Johnstone B, Hering TM, Caplan AI, Goldberg VM, Yoo JU. In vitro chondrogenesis of bone marrow-derived mesenchymal progenitor cells. Exp Cell Res 1998;238:265-72.
  33. Mancuso P, Raman S, Glynn A, Barry F, Murphy JM. Mesenchymal stem cell therapy for osteoarthritis: The critical role of the cell secretome. Front Bioeng Biotechnol2019;7..
  34. Bastos R, Mathias M, Andrade R, Amaral RJ, Schott V, Balduino A, et al. Intra-articular injection of culture-expanded mesenchymal stem cells with or without addition of platelet-rich plasma is effective in decreasing pain and symptoms in knee osteoarthritis: A controlled, double-blind clinical trial. Knee Surg Sports Traumatol Arthrosc 2020;28:1989-99.
  35. Lee WS, Kim HJ, Kim KI, Kim GB, Jin W. Intra-articular injection of autologous adipose tissue-derived mesenchymal stem cells for the treatment of knee osteoarthritis: A phase IIb, randomized, placebo-controlled clinical trial. Stem Cells Transl Med 2019;8:504-11.
  36. Song Y, Zhang J, Xu H, Lin Z, Chang H, Liu W, et al. Mesenchymal stem cells in knee osteoarthritis treatment: A systematic review and meta-analysis. J Orthop Translat 2020;24:121-30.
  37. Lamo-Espinosa JM, Mora G, Blanco JF, Granero-Moltó F, Núñez-Córdoba JM, López-Elío S, et al. Intra-articular injection of two different doses of autologous bone marrow mesenchymal stem cells versus hyaluronic acid in the treatment of knee osteoarthritis: Long-term follow up of a multicenter randomized controlled clinical trial (phase I/II). J Transl Med 2018;16.
  38. Momaya AM, McGee AS, Dombrowsky AR, Wild AJ, Faroqui NM, Waldrop RP, et al. The cost variability of orthobiologics. Sports Health 2020;12:94-8.
  39. Sconza C, Respizzi S, Virelli L, Vandenbulcke F, Iacono F, Kon E, et al. Oxygen-Ozone therapy for the treatment of knee osteoarthritis: A systematic review of randomized controlled trials. Arthroscopy 2020;36:277-86.
  40. Costa T, Rodrigues-Manica S, Lopes C, Gomes J, Marona J, Falcão S, et al. Ozone therapy in knee osteoarthritis: A systematic review. Acta Med Port 2018;31:576-80.
  41. De Jesus CC, DosSantos FC, deJesus LM, MonteiroI, Sant’AnaMS, TrevisaniVF. Comparison between intra-articular ozone and placebo in the treatment of knee osteoarthritis: A randomized, double-blinded, placebo-controlled study.PLoS One2017;12:
  42. Raeissadat SA, Hosseini PG, Bahrami MH, Roghani RS, Fathi M, Ahangar AG, et al. The comparison effects of intra-articular injection of platelet rich plasma (PRP), plasma rich in growth factor (PRGF), hyaluronic acid (HA), and ozone in knee osteoarthritis; a one year randomized clinical trial. BMC Musculoskelet Disord 2021;22:134.
  43. Duymus TM, Mutlu S, Dernek B, Komur B, Aydogmus S, Kesiktas FN. Choice of intra-articular injection in treatment of knee osteoarthritis: Platelet-rich plasma, hyaluronic acid or ozone options. Knee Surg Sports Traumatol Arthrosc 2017;25:485-92.
  44. Giombini A, Menotti F, Di Cesare A, Giovannangeli F, Rizzo M, Moffa S, et al. Comparison between intrarticular injection of hyaluronic acid, oxygen ozone, and the combination of both in the treatment of knee osteoarthrosis. J Biol Regul Homeost Agents 2016;30:621-5.
  45. Sert AT, Sen EI, Esmaeilzadeh S, Ozcan E. The effects of dextrose prolotherapy in symptomatic knee osteoarthritis: A randomized controlled study. J Altern Complement Med 2020;26:409-17.
  46. Sit RW, Wu RW, Rabago D, Reeves KD, Chan DC, Yip BH, et al. Efficacy of intra-articular hypertonic dextrose (prolotherapy) for knee osteoarthritis: A randomized controlled trial. Ann Fam Med 2020;18:235-42.
  47. Rabago D, Mundt M, Zgierska A, Grettie J. Hypertonic dextrose injection (prolotherapy) for knee osteoarthritis: Long term outcomes. Complement Ther Med 2015;23:388-95.
  48. Arias-Vázquez PI, Tovilla-Zárate CA, Legorreta-Ramírez BG, Fonz WB, Magaña-Ricardez D, González-Castro TB, et al. Prolotherapy for knee osteoarthritis using hypertonic dextrose vs other interventional treatments: Systematic review of clinical trials. Adv Rheumatol 2019;59:39.
  49. Iannaccone F, Dixon S, Kaufman A. A review of long-term pain relief after genicular nerve radiofrequency ablation in chronic knee osteoarthritis. Pain Physician 2017;20:E437-44.
  50. Kapural L, Deering JP. A technological overview of cooled radiofrequency ablation and its effectiveness in the management of chronic knee pain. Pain Manag 2020;10:133-40.
  51. Kocayiğit H, Beyaz SG. Comparison of cooled and conventional radiofrequency applications for the treatment of osteoarthritic knee pain. J Anaesthesiol Clin Pharmacol 2021;37:464-8.
  52. Stake S, Agarwal AR, Coombs S, Cohen JS, Golladay GJ, Campbell JC, et al. Total knee arthroplasty after genicular nerve radiofrequency ablation: Reduction in prolonged opioid use without increased postsurgical complications. J Am Acad Orthop Surg Glob Res Rev 2022;6:e22.00125.
  53. Mishra P, Edwards D, Huntoon M, Sobey C, Polkowski G, Corey J, et al. Is preoperative genicular radiofrequency ablation effective for reducing pain following total knee arthroplasty? A pilot randomized clinical trial. Reg Anesth Pain Med 2021;46:752-6.
  54. Qudsi-Sinclair S, Borrás-Rubio E, Abellan-Guillén JF, Del Rey ML, Ruiz-Merino G. A comparison of genicular nerve treatment using either radiofrequency or analgesic block with corticosteroid for pain after a total knee arthroplasty: A double-blind, randomized clinical study. Pain Pract2017;17:578-88.
  55. Protzman NM, Gyi J, Malhotra AD, Kooch JE. Examining the feasibility of radiofrequency treatment for chronic knee pain after total knee arthroplasty. PM R2014;6:373-6.
  56. Hunter C, Davis T, Loudermilk E, Kapura lL, DePalma M. Cooled radiofrequency ablation treatment of the genicular nerves in the treatment of osteoarthritic knee pain: 18- and 24-month results. Pain Pract 2020;20:238-46.
  57. Chen A, Khalouf F, Zora K, DePalma M, Kohan L, Guirguis M, et al. Cooled radiofrequency ablation compared with a single injection of hyaluronic acid for chronic knee pain: A multicenter, randomized clinical trial demonstrating greater efficacy and equivalent safety for cooled radiofrequency ablation. J Bone Joint Surg Am 2020;102:1501-10.
  58. Elawamy A, Kamel EZ, Mahran SA, Abdellatif H, Hassanien M. Efficacy of genicular nerve radiofrequency ablation versus intra-articular platelet rich plasma in chronic knee osteoarthritis: A single-blind randomized clinical trial. Pain Physician 2021;24:127-34.
  59. Felson DT. Arthroscopy as a treatment for knee osteoarthritis. Best Pract Res Clin Rheumatol 2009;24:47-50.
  60. Krych AJ, Bert JM, Levy BA. Treatment of OA of the knee in the middle-aged athlete: The role of arthroscopy. Sports Med Arthrosc Rev2013;21:23-30.
  61. Brophy RH, Fillingham YA. AAOS clinical practice guideline summary: Management of osteoarthritis of the knee (Nonarthroplasty), Third Edition. J Am Acad Orthop Surg 2022;30:e721-9.
  62. Spahn G, Mückley T, Kahl E, Hofmann GO. Factors affecting the outcome of arthroscopy in medial-compartment osteoarthritis of the knee. Arthroscopy 2006;22:1233-40.
  63. Dearing J, Nutton RW. Evidence based factors influencing outcome of arthroscopy in osteoarthritis of the knee. Knee 2008;15:159-63.
  64. Brignardello-Petersen R, Guyatt GH, Buchbinder R, Poolman RW, Schandelmaier S, Chang Y, et al. Knee arthroscopy versus conservative management in patients with degenerative knee disease: A systematic review. BMJ Open 2017;7:e016114.
  65. Delva ML, Samuel LT, Roth A, Yalçin S, Kamath AF. Contemporary knee osteotomy in the United States: High tibial osteotomy and distal femoral osteotomy have comparable complication rates despite differing demographic profiles. J Knee Surg 2021;34:816-21.
  66. Wang JW, Hsu CC. Distal femoral varus osteotomy for osteoarthritis of the knee. Surgical technique. J Bone Joint Surg Am 2006;88 Suppl 1 Pt 1:100-8.
  67. Pornrattanamaneewong C, Ruangsomboon P, Narkbunnam R, Chareancholvanich K. Medial closing-wedge distal femoral varusosteotomy via lateral approach: The modified technique for treating valgus osteoarthritic knee as case series. Siriraj Medical Journal. 2022;74(11):747-753.
  68. Ren YM, Tian MQ, Duan YH, Sun YB, Yang T, Hou WY. Distal tibial tubercle osteotomy can lessen change in patellar height post medial opening wedge high tibial osteotomy? A systematic review and meta-analysis. J Orthop Surg Res 2022;17:
  69. Amendola A, Bonasia DE. Results of high tibial osteotomy: Review of the literature. Int Orthop 2009;34:155-60.
  70. LaPrade RF, Spiridonov SI, Nystrom LM, Jansson KS. Prospective outcomes of young and middle-aged adults with medial compartment osteoarthritis treated with a proximal tibial opening wedge osteotomy. Arthroscopy 2012;28:354-64.
  71. Kunze KN, Beletsky A, Hannon CP, LaPrade RF, Yanke AB, Cole BJ, et al. Return to work and sport after proximal tibial osteotomy and the effects of opening versus closing wedge techniques on adverse outcomes: A systematic review and meta-analysis. Am J Sports Med 2020;48:2295-304.
  72. Ekhtiari S, Haldane CE, deSa D, Simunovic N, Musah lV, Ayeni OR. Return to work and sport following high tibial osteotomy: A systematic review. J Bone Joint Surg Am 2016;98:1568-77.
  73. Jackson JP, Waugh W. Tibial osteotomy for osteoarthritis of the knee. J Bone Joint Surg Br 1961;43-B:746-51.
  74. Aglietti P, Buzzi R, Vena LM, Baldini A, Mondaini A. High tibial valgus osteotomy for medial gonarthrosis: A 10- to 21-year study. J Knee Surg 2003;16:21-6.
  75. Sprenger TR, Doerzbacher JF. Tibial osteotomy for the treatment of varus gonarthrosis. Survival and failure analysis to twenty-two years. J Bone Joint Surg Am 2003;85:469-74.
  76. Wu L, Hahne HJ, Hassenpflug T. Long-term follow-up study of high tibial osteotomy for medial compartment osteoarthrosis. Chin J Traumatol 2004;7:348-53.
  77. Bonasia DE, Dettoni F, Sito G, Blonna D, Marmotti A, Bruzzone M, et al. Medial opening wedge high tibial osteotomy for medial compartment overload/arthritis in the varus knee. Am J Sports Med 2014;42:690-8.
  78. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Does obesity and nicotine abuse influence the outcome and complication rate after open-wedge high tibial osteotomy? A retrospective evaluation of five hundred and thirty three patients. Int Orthop 2014;38:55-60.
  79. Floerkemeier S, Staubli AE, Schroeter S, Goldhahn S, Lobenhoffer P. Outcome after high tibial open-wedge osteotomy: A retrospective evaluation of 533 patients. Knee Surg Sports Traumatol Arthrosc 2013;21:170-80.
  80. Salzmann GM, Ahrens P, Naal FD, El-Azab H, Spang JT, Imhoff AB, et al. Sporting activity after high tibial osteotomy for the treatment of medial compartment knee osteoarthritis. Am J Sports Med 2009;37:312-8.
  81. Schuster P, Geßlein M, Schlumberger M, Mayer P, Mayr R, Oremek D, et al. Ten-year results of medial open-wedge high tibial osteotomy and chondral resurfacing in severe medial osteoarthritis and varus malalignment. Am J Sports Med 2018;46:1362-70.
  82. Dugdale TW, Noyes FR, Styer D. Preoperative planning for high tibial osteotomy. The effect of lateral tibiofemoral separation and tibiofemoral length. Clin Orthop Relat Res1992;274:248-64.
  83. Kosashvili Y, Safir O, Gross A, Morag G, Lakstein D, Backstein D. Distal femoral varus osteotomy for lateral osteoarthritis of the knee: A minimum ten-year follow-up. Int Orthop 2010;34:249-54.
  84. Coventry M. Osteotomy about the knee for degenerative and rheumatoid arthritis. J Bone Joint Surg Am 1973;55:23-48.
  85. Buda R, Castagnini F, Gorgolini G, Baldassarri M, Vannini F. Distal femoral medial closing wedge osteotomy for degenerative valgus knee: Mid-term results in active patients. Acta Orthop Belg 2017;83:140-5.

 

How to Cite this article: Reddy RG, Wang Y, Scully R, Thakkar SC. Invasive Non-arthroplasty Treatment Options for Knee Osteoarthritis: Review. Journal of Clinical Orthopaedics Jan-Jun 2023;8(1):08-17.

 (Abstract    Full Text HTML)   (Download PDF)

Burnout in COVID-19 Residency

/in /by

Journal of Clinical Orthopaedics | Vol 8 | Issue 1 |  Jan-Jun 2023 | page: 18-24 | Sachin Kale, Pratik Dhabalia, Ajit Chalak, Abhiraj Patel, Abhineet Chand, Sonali Das

DOI: :10.13107/jcorth.2023.v08i01.551

Author: Sachin Kale [1], Pratik Dhabalia [1], Ajit Chalak [1], Abhiraj Patel [1], Abhineet Chand [1], Sonali Das [1]

[1] Department of Orthopaedics, DY Patil Medical College and Hospital, Nerul, Navi Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Abhiraj Patel,

Department of Orthopaedics, DY Patil Medical College and Hospital, Nerul, Navi Mumbai, Maharashtra, India.

E-mail: abhirajpatel15@gmail.com

Abstract

Introduction: Burnout is a syndrome denoting the outcome of chronic work stress which has not been managed successfully. Burnout has only sometimes been at the forefront of studies in healthcare, where patient care and management have received more attention. This study focuses particularly on burnout of residents and healthcare workers during the COVID-19 pandemic that has changed the working environment.

Material and Methods: Questionnaires in the form of surveys have been used to receive feedback regarding work experience within the bubble of isolation and high patient load unique to COVID-19 pandemic. A full and complete analysis of the research is provided after the definition, description, and measurement of burnout are given.

Results: According to a review of the burnout literature, burnout affects medical students, residents, and practicing doctors, with prevalence rates ranging from 28% to 45% for each group. First-year residency during the COVID-19 pandemic, in particular, is plagued with unmanageable burnout symptoms and a depleted support system. Burnout among residents is said to be caused by time demands, a lack of control, poor work organization, naturally challenging employment settings, and interpersonal connections. Workplace solutions might take the form of burnout education, workload adjustments, diversifying job roles, stress management training, mentorship, emotional intelligence seminars, and training in emotional intelligence. In addition, developing interpersonal and professional relationships, meditation, therapy, and exercise are examples of self-directed behavioral, social, and physical activities..

Conclusion: Educators should consider including pertinent instructions and interventions during the process of instructing resident doctors. In addition, they should actively become aware of burnout. Early detection aids in better management of burnout.

Keywords: burnout, COVID-19, residency, work-life balance.

References

  1. Freudenberger HJ. Staff burnout. J Soc Issues 1974;30:159-65.
  2. Melamed S, Shirom A, Toker S, Berliner S, Shapira I. Burnout and risk of cardiovascular disease: Evidence, possible causal paths, and promising research directions. Psychol Bull 2006;132:327-53.
  3. Cohen JS, Patten S. Well-being in residency training: A survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta. BMC Med Educ 2005;22:21.
  4. Sherman MD. Distress and professional impairment due to mental health problems among psychotherapists. Clin Psychol Rev 1996;16:299-315.
  5. Solomon M. Therapeutic depletion and burnout in countertransference. In: Siegel J, editor. Couples Therapy. New York: WW Norton; 1997.
  6. Halbesleben JR, Rathert C. Linking physician burnout and patient outcomes: Exploring the dyadic relationship between physicians and patients. Health Care Manage Rev 2008;33:29-39.
  7. Kottler JA. On Being a Therapist. San Francisco, CA: Jossey-Bass; 1986.
  8. Ahola K, Honkonen T, Pirkola S, Isometsä E, Kalimo R, Nykyri E, et al. Alcohol dependence in relation to burnout among the Finnish working population. Addiction 2006;101:1438-43.
  9. Maslach C, Jackson SE, Leiter MP. Maslach Burnout Inventory Manual. 3rd Palo Alto, CA: Consulting Psychologists Press; 1996.
  10. Maslach C, Jackson SE, Leiter M. The Maslach burnout inventory. In: Zalaquett CP, Wood RJ, editor. Evaluating Stress: A Book of Resources. 3rd Lanham, MD: Scarecrow Press; 1997.
  11. Purdy RR, Lemkau JP, Rafferty JP, Rudisill JR. Resident physicians in family practice: Who’s burned out and who knows? Fam Med 1987;19:203-8.
  12. Dupree P, Day HD. Psychotherapists’ Job Satisfaction and Job Burnout as a Function of Work Setting and Percentage of Managed Care Clients. New York: Haworth Press; 1995.
  13. Nyssen AS, Hansez I, Baele P, Lamy M, De Keyser V. Occupational stress and burnout in anaesthesia. Br J Anaesth 2003;90:333-7.
  14. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-reported patient care in an internal medicine residency program. Ann Intern Med 2002;136:358-67.
  15. Woodside JR, Miller MN, Floyd MR, McGowen KR, Pfortmiller DT. Observations on burnout in family medicine and psychiatry residents. Acad Psych 2008;32:13-9.
  16. Lemkau JP, Purdy RR, Rafferty JP, Rudisill JR. Correlates of burnout among family practice residents. J Med Educ 1988;63:682-91.
  17. West CP, Huschka MM, Novotny PJ. Association of perceived medical errors with resident distress and empathy: A prospective longitudinal study. JAMA 2006;296:1071-8.
  18. Eckleberry-Hunt J, Lick D, Boura J, Hunt R, Balasubramaniam M, Mulhem E, et al. An exploratory study of resident burnout and wellness. Acad Med 2009;84:269-77.
  19. Ramanan RA, Taylor WC, Davis RB, Phillips RS. Mentoring matters: mentoring and career preparation in internal medicine residency training. J Gen Intern Med 2006;21:340-5.
  20. Vuori I. Does physical activity enhance healthy? Patient Educ Couns 1998;33:S95-103.
  21. Sherman MD, Thelen MH. Distress and professional impairment among psychologists in clinical practice. Prof Psychol Res Pract 1998;29:79-85.
  22. Macaskill N, Macaskill A. Psychotherapists-in-training evaluate their personal therapy: Results of a UK study. Br J Psychother 1992;9:133-8.

 

How to Cite this article: Kale S, Dhabalia P, Chalak A, Patel A, Chand A, Das S. Burnout in COVID-19 Residency. Journal of Clinical Orthopaedics Jan-Jun 2023;8(1):18-24.

 (Abstract    Full Text HTML)   (Download PDF)

When all is not good – managing an adolescent with Osgood Schlatter disease

/in /by

Journal of Clinical Orthopaedics | Vol 8 | Issue 1 |  Jan-Jun 2023 | page: 25-31 | Tushar Agarwal, Pooja Suratwala

DOI: 10.13107/jcorth.2023.v08i01.557

Author: Tushar Agarwal [1], Pooja Suratwala [2]

[1] Aastha Hospital, 65 Balasinor Society, SV Road Kandivali West, Mumbai 67 India,
[2] Clinical Fellow Paediatric Orthopaedics, Aastha Hospital, Kandivali, India.

Address of Correspondence
Dr. Tushar Agrawal,

Aastha Hospital, 65 Balasinor Society, SV Road Kandivali West, Mumbai 67, India.
E-mail: drtusharagrawal@gmail.com

Abstract

Anterior knee pain in children above 10 years of age is a part of every orthopaedic surgeon OPD practice. Osgood-Schlatter disease is the most common cause in skeletal of immature athletic children. It is a condition, in which the patellar tendon insertion on the tibial tuberosity becomes inflamed. It tends to occur more commonly in boys and it occurs in the second decade of life ( 10-15 years). It is a self limiting condition and and occurs secondary to repetitive extensor mechanism stress activities such as jumping and sprinting. OSD is a clinical diagnosis, and only radiographic evaluation may be done to confirm the diagnosis. Pain level dictates overall treatment, and management includes symptomatic treatment with ice and NSAIDs, as well as activity modification. & relative rest from inciting activities in association with lower extremities stretching exercises. In this paper we discuss the etiology, presentation, evaluation, and management of osgood schlatter disease.

Keywords: osgood Schlatter disease , osteochondritis, anterior knee pain.

References

  1. Vaishya R, Azizi AT, Agarwal AK, Vijay V. Apophysitis of the tibial tuberosity (Osgood-Schlatter disease): A review. Cureus 2016;8:e780.
  2. Ladenhauf HN, Seitlinger G, Green DW. Osgood-Schlatter disease: A 2020 update of a common knee condition in children. Curr Opin Pediatr 2020;32:107-12.
  3. Nowinski RJ, Mehlman CT. Hyphenated history-Osgood-Schlatter diease. Am J Orthop (Belle Mead NJ) 1998;27:584-5.
  4. Gaulrapp H, Nührenbörger C. The Osgood-Schlatter disease: Alarge clinical series with evaluation of risk factors, natural course, and outcomes. Int Orthop 2022;46:197-204.
  5. Green DW, Sidharthan S, Schlichte LM, Aitchison AH, Mintz DN. Increased posterior tibial slope in patients with Osgood-Schlatter disease: A new association. Am J Sports Med 2020;48:642-6.
  6. Uzunov V. A look at the pathophysiology and rehabilitation of Osgood-Schlatter Syndrome. Gym Coach 2008;2:39-45.
  7. Demirag B, Ozturk C, Yazici Z, Sarisozen B. The pathophysiology of Osgood-Schlatter disease: A magnetic resonance investigation. J Pediatr Orthop B 2004;13:379-82.
  8. Kadirhan O, Fatihoglu E. Magnetic resonance imaging findings in Osgood Schlatter disease: Acase report. Curr Res MRI 2022;1:50-1.
  9. Siddiq MA. Osgood-Schlatter disease unveiled under high-frequency ultrasonogram. Cureus 2018;10:e3411.
  10. Neuhaus C, Appenzeller-Herzog C, Faude O. A systematic review on conservative treatment options for OSGOOD-Schlatter disease. Phys Ther Sport 2021;49:178-87.
  11. Topol GA, Podesta LA, Reeves KD, Raya MF, Fullerton BD, Yeh HW. Hyperosmolar dextrose injection for recalcitrant Osgood-Schlatter disease. Pediatrics 2011;128:e1121-8.
  12. Weiss JM, Jordan SS, Andersen JS, Lee BM, Kocher M. Surgical treatment of unresolved Osgood-Schlatter disease: Ossicle resection with tibial tubercleplasty. J Pediatr Orthop 2007;27:844-7.
  13. Tsakotos G, Flevas DA, Sasalos GG, Benakis L, Tokis AV. Osgood-Schlatter lesion removed arthroscopically in an adult patient. Cureus 2020;12:e7362.
  14. Fujita K, Nakase J, Yoshimizu R, Kimura M, Kanayama T, Tsuchiya H. Bursoscopic ultrasound-guided ossicle resection for Osgood-Schlatter disease. Arthrosc Tech 2022;11:e841-6.
  15. Pihlajamäki HK, Mattila VM, Parviainen M, Kiuru MJ, Visuri TI. Long-term outcome after surgical treatment of unresolved Osgood-Schlatter disease in young men. J Bone Joint Surg Am 2009;91:2350-8.
  16. Circi E, Atalay Y, Beyzadeoglu T. Treatment of Osgood-Schlatter disease: Review of the literature. Musculoskelet
    Surg 2017;101:195-200.
  17. Corbi F, Matas S, Álvarez-Herms J, Sitko S, Baiget E, Reverter-Masia J, et al. Osgood-Schlatter disease: Appearance, diagnosis and treatment: A narrative review. Healthcare (Basel) 2022;10:1011.
How to Cite this article: Agarwal T, Suratwala P. When All Is Not Good – Managing an Adolescent with Osgood–Schlatter Disease. Journal of Clinical Orthopaedics Jan-Jun 2023;8(1):25-31.

 (Abstract    Full Text HTML)   (Download PDF)

Non Standard Deviation – Managing angular deformities around the knee in young age

/in /by

Journal of Clinical Orthopaedics | Vol 8 | Issue 1 |  Jan-Jun 2023 | page: 32-37 | Binoti Sheth

DOI: 10.13107/jcorth.2023.v08i01.559

Author: Binoti Sheth [1]

[1] Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, Mumbai, India.

Address of Correspondence
Dr. Binoti Sheth, MS, DNB, FCPS, D. Orth.
Professor and Head of Unit, Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General
Hospital, Sion, Mumbai, India.
E-mail: binotisheth@yahoo.com

Abstract

Angular deformities around the knee in children are common presentations in day to day practice. While some of the deformities are physiological that need careful observation, the others are pathological and need timely medical or surgical intervention. Systematic evaluation of the deformity is the first step in making the correct decision about the management. The right choice of treatment, the correct timing and perfect execution of the technique are necessary for optimum outcome. This article describes the aetiology, clinicoradiological evaluation and management of angular deformities around the knee in children.

Keywords: Knee, Angular deformity, Children.

References

  1. SeleniusP., Vankka E.: The development of the tibiofemoral angle in children J. Bone Joint Surg Am.1975, 57:259-261.
  2. Valentino Coppa, Mario Marinelli: Coronal plane deformity around the knee in the skeletally immature population: A review of principles of evaluation and treatment World Journal of Orthopaedics 2022, May 13(5):427-443.
  3. Davids JR, Blackhurst DW. Clinical evaluation of bowed legs in children JPO B 2000 Oct 9(4): 278-284.
  4. Paley D. Principles of deformity correction Heidelberg, Springer, 2002:1-18.
  5. Paley D, Tetsworth K. Mechanical axis deviation of the lower limbs: Preoperative planning of uniapical angular deformities of the tibia or femur CORR 1992, 48-64.
  6. Stevens PM. Guided growth for angular correction: a preliminary series using a tension band plate JPO 2007, 27:253-259.
  7. Eltayeby HH, Lobst CA. Hemiepiphysiodesis using tension band plates: does the initial screw angle influence the rate of correction? J. Child Ortho. 2019, Feb. 13(1): 62-66.
  8. Metaizeau JP, Wong-ChungJ. Percutaneous epiphysiodesis using transphyseal screws(PETS) JPO1998,18:363-369.
  9. White GR, Mencio GA: Genu valgum in children: Diagnostic and therapeutic alternatives JAAOS:1995;3 (5):275-283.
  10. Tachdjian’s Paediatric Orthopaedics. 3rd ed. 2002, Vol. 3:839-890.
How to Cite this article: Sheth B. Non Standard Deviation – Managing angular deformities around the knee in young agee. Journal of Clinical Orthopaedics Jan-Jun 2023;8(1):32-37.

 (Abstract    Full Text HTML)   (Download PDF)

 

Bracing for Impact – Bracing in Adolescent Idiopathic Scoliosis

/in /by

Journal of Clinical Orthopaedics | Vol 8 | Issue 1 |  Jan-Jun 2023 | page: 38-40 | Kshitij Chaudhary

DOI: 10.13107/jcorth.2023.v08i01.561

Author: Kshitij Chaudhary [1]

[1] Orthopaedic Spine Surgeon, Department of Orthopaedics, P.D. Hinduja National Hospital and Research Centre,
Mumbai, Maharashtra, India..

Address of Correspondence
Dr. Kshitij Chaudhary,
1417, OPD Building, PD hinduja Hospital and Research Center, Veer Savarkar Marg, Mahim, Mumbai, 400016, India.
E-mail: chaudhary.kc@gmail.com

Abstract

Bracing plays a vital role in the non-operative treatment of adolescent idiopathic scoliosis (AIS), especially when detected early. Recent high-quality studies confirm that bracing can alter the natural progression of a curve, potentially preventing the need for surgery. The concept is based on the ability of external force to guide spine growth, which has been experimentally proven. However, bracing cannot straighten the spine; its primary goal is to halt the curve’s progression. The evidence for bracing is strong, with studies showing that approximately two-thirds of AIS curves can be controlled through bracing. However, there are concerns about the broad application of bracing indications, potentially leading to unnecessary treatment for some patients. Identifying the 25% of patients who will benefit from bracing remains a challenge. Bracing is most effective when applied to curves between 25-45° during the rapid growth phase, but compliance is crucial for success. The choice of brace type matters less than its quality and corrective effect. The practice of bracing requires a close orthotist-surgeon relationship, and follow-up visits are essential to monitor progress. Ultimately, bracing remains a valuable non-surgical option for AIS, but careful patient selection and close monitoring are necessary for optimal results.

Keywords: Brace, Adolescent idiopathic scoliosis.

References

  1. Weinstein SL, Dolan L A, Wright JG, Dobbs MB. Effects of bracing in adolescents with idiopathic scoliosis. New England J Med 2013;369(16):1512-1521.
  2. Nachemson AL. Long-term effect of brace treatment on nonoperated immature idiopathic scoliosis followed to skeletal maturity. Spine 1995;20(12):1363-1367.
  3. Winter RB, Lonstein JE, Denis F, Johnson L. Scoliosis: etiology, diagnosis, and natural history. J Pediatric Ortho 1983;3(4):341-351.
  4. Karol LA, Johnston CE, Browne RH, Madison M, Birch J. Bracing as a treatment for adolescent idiopathic scoliosis: a prospective cohort study. J Pediatric Ortho 2008;28(7):753-759.
  5. Aronsson DD, Stokes IA. Nonfusion treatment of adolescent idiopathic scoliosis by growth modulation and remodeling. J Pediatr Orthop. 2011;31(1 Suppl):S99-106.
How to Cite this article: Chaudhary K. Bracing for Impact – Bracing in Adolescent Idiopathic Scoliosis. Journal of Clinical Orthopaedics Jan-Jun 2023;8(1):38-40.

 (Abstract    Full Text HTML)   (Download PDF)

Foot Falls – Managing Flatfeet in Children and Adolescents

/in /by

Journal of Clinical Orthopaedics | Vol 8 | Issue 1 |  Jan-Jun 2023 | page: 41-46 | Ranjit Deshmukh

DOI: 10.13107/jcorth.2023.v08i01.563

Author: Ranjit Deshmukh [1]

[1] Consultant Orthopaedic Surgeon, Blooming Buds Paediatric Orthopaedics Department, Deenanath Mangeshkar
Hospital, Pune, Maharashtra, India.

Address of Correspondence
Dr. Ranjit Deshmukh,
Consultant Orthopedic Surgeon, Blooming Buds Paediatric Orthopaedics Department, Deenanath Mangeshkar
Hospital, Pune, Maharashtra, India.
E-mail: drranjitdeshmukh@gmail.com

Abstract

Flat feet are rarely symptomatic in children. The reason for consultation is usually parental anxiety and peer pressure. Majority of the patients and their parents needs to be treated with assurance. The clinical assessment of the foot must however be performed systematically in order to detect signs of symptomatic flat feet that are detected early and treated within time. Asymptomatic flexible flat feet constitute the majority of these feet and need to be assessed for a tight tendo achilles. Feet with a tight tendo achilles are most likely to become symptomatic and may need some form of treatment. The treatment is primarily conservative however in exceptional circumstances joint sparing osteo tomies of the feet are recommended Evaluation of the foot should detect any signs of a rigid flat foot. The cause of rigidity if established early can be addressed to prevent long term morbidity.

Keywords: :Flexible Flatfoot, Rigid Flatfoot Achilles tendon contracture, Foot Osteotomies.

References

  1. Mosca VS. Flexible flatfoot in children and adolescents. J Child Orthop 2010;4:107-21.
  2. Harris RI, Beath T. Army Foot Survey: An Investigation of Foot Ailments in Canadian Soldiers. Vol. 1. Ottawa, Ontario: National Research Council of Canada; 1947. p. 1-268.
  3. Staheli LT, Chew DE, Corbett M. The longitudinal arch: A survey of eight hundred and eighty-two feet in normal children and adults. J Bone Joint Surg Am 1987;69:426-8.
  4. Evans AM, Rome K. A Cochrane review of the evidence for non-surgical interventions for flexible pediatric flat feet. Eur J Phys Rehabil Med 2011;47:69-89.
  5. Pfeiffer M, Kotz R, Ledl T, Hauser G, Sluga M. Prevalence of flat foot in preschool-aged children. Pediatrics 2006;118:634-9.
  6. Rao UB, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 2300 children. J Bone Joint Surg Br 1992;74:525-7.
  7. Sachithanandam V, Joseph B. The influence of footwear on the prevalence of flat foot. A survey of 1846 skeletally mature persons. J Bone Joint Surg Br 1995;77:254-7.
  8. Duchenne GB. Physiology of Motion. Philadelphia, PA: WB Saunders; 1959. p. 337.
  9. Basmajian JV, Stecko G. The role of muscles in arch support of the foot: An electromyographic study. J Bone Joint Surg Am 1963;45:1184-90.
  10. Mosca VS. Calcaneal lengthening for valgus deformity of the hind foot: Results in children who had severe, symptomatic flatfoot and skew foot. J Bone Joint Surg Am 1995;77:500-12.
  11. Bouchard M, Mosca VS. Flatfoot deformity in children and adolescents: Surgical indications and management. J Am Acad Orthop Surg 2014;22:623-32.
  12. Meary R. On the measurement of the angle between the talus and the first metatarsal: Symposium. Le Pied creux essential. Rev Chir Orthop 1967;53:389-467.
  13. Davids JR, Gibson TW, Pugh LI. Quantitative segmental analysis of weight bearing radiographs of the foot and ankle for children: Normal alignment. J Pediatr Orthop 2005;25:769-76.
  14. Wenger DR, Mauldin D, Speck G, Morgan D, Lieber RL. Corrective shoes and inserts as treatment for flexible flatfoot in infants and children. J Bone Joint Surg Am 1989;71:800810.
  15. Mann R, Inman VT. Phasic activity of intrinsic muscles of the foot. J Bone Joint Surg Am 1964;46:469-81.
  16. Bordelon RL. Correction of hypermobile flatfoot in children by molded insert. Foot Ankle 1980;1:143-50.
  17. MacKenzie AJ, Rome K, Evans AM. The efficacy of nonsurgical interventions for pediatric flexible flat foot: A critical review. J Pediatr Orthop 2012;32:830-4.
  18. Rathjen KE, Mubarak SJ. Calcaneal cuboid-cuneiform osteotomy for the correction of valgus foot deformities in children. J Pediatr Orthop 1998;18:775-82.
  19. Dobbs MB, Purcell DB, Nunley R, Morcuende JA. Early results of a new method of treatment for idiopathic congenital vertical talus. J Bone Joint Surg Am 2006;88:1192-200.
  20. Mazzocca AD, Thomson JD, Deluca PA, Romness MJ. Comparison of the posterior approach versus the dorsal approach in the treatment of congenital vertical talus. Pediatr Orthop 2001;21:212-7.
  21. Mosca VS, Bevan WP. Talocalcaneal tarsal coalitions and the calcaneal lengthening osteotomy: The role of deformity correction. J Bone Joint Surg Am 2012;94:1584-94.
  22. Gantsoudes GD, Roocroft JH, Mubarak SJ. Treatment of talocalcaneal coalitions. J Pediatr Orthop 2012;32:301-7.
  23. Khoshbin A, Law PW, Caspi L, Wright JG. Long-term functional outcomes of resected tarsal coalitions. Foot Ankle Int 2013;34:1370-5.
  24. Wilde PH, Torode IP, Dickens DR, Cole WG. Resection for symptomatic talocalcaneal coalition. J Bone Joint Surg Br 1994;76:797-801.
  25. Scranton PE Jr. Treatment of symptomatic talocalcaneal coalition. J Bone Joint Surg Am 1987;69:533-9.
How to Cite this article: Deshmukh R. Foot Falls – Managing Flatfeet in Children and Adolescents. Journal of Clinical Orthopaedics Jan-Jun 2023;8(1):41-46.

 (Abstract    Full Text HTML)   (Download PDF)

The Boon in a toxin : Injection Botulinum Toxin for Spasticity management in Children with Cerebral Palsy

/in /by

Journal of Clinical Orthopaedics | Vol 8 | Issue 1 |  Jan-Jun 2023 | page: 47-50 | Chasanal Rathod

DOI: 10.13107/jcorth.2023.v08i01.565

Author: Chasanal Rathod [1]

[1] Department of Orthopedics, SRCC Children’s Hospital, Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Chasanal Rathod,
Department of Orthopedics, SRCC Children’s Hospital, Mumbai, Maharashtra, India.
E-mail: chasanal@gmail.com

References

  1. Multani I, Manji J, Hastings-Ison T, Khot A, Graham K. Botulinum toxin in the management of children with cerebral palsy. Paediatr Drugs 2019;21:261-81.
  2. Car H, Bogucki A, Bonikowski M, Dec-Ćwiek M, Drużdż A, Koziorowski D, et al. Botulinum toxin type-A preparations are not the same medications-basic science (Part 1). Neurol Neurochir Pol 2021;55:133-40.
  3. Sätilä H. Over 25 years of pediatric Botulinum toxin treatments: What have we learned from injection techniques, doses, dilutions, and recovery of repeated injections? Toxins (Basel) 2020;12:440.
  4. Graham HK, Aoki KR, Autti-Ramo I, Boyd RN, Delgado MR, Gaebler-Spira DJ, et al. Recommendations for the use of botulinum toxin type A in the management of cerebral palsy. Gait Posture 2000;11:67-79.
  5. Reeuwijk A, Van Schie PE, Becher JG, Kwakkel G. Effects of botulinum toxin type A on upper limb functions in children with cerebral palsy: A systematic review. Clin Rehabil 2006;20:375-87.
  6. Schroeder AS, Berweck S, Lee SH, Heinen F. Botulinum toxin treatment in children with cerebral palsy-a short review of different injection techniques. Neurotox Res 2006;9:189-96.
  7. Kinnett D. Botulinum toxin Ainjections in children: Technique and dosing issues. Am J Phys Med Rehabil 2004;83(Suppl 10):S59-64.
  8. Fehlings D, Rang M, Glazier J, Steele C. An evaluation of botulinum-A toxin injections to improve upper extremity function in children with hemiplegic cerebral palsy. J Pediatr 2000;137:331-7.
  9. Jefferson RJ. Botulinum toxin in the management of cerebral palsy. Dev Med Child Neurol 2004;46:491-9.
  10. Read FA, Boyd RN, Barber LA. Longitudinal assessment of gait quality in children with bilateral cerebral palsy following repeated lower limb intramuscular botulinum toxin-Ainjections. Res Dev Disabil 2017;68:35-41.

 

How to Cite this article: Rathod C. The Boon in a Toxin: Injection Botulinum Toxin for Spasticity Management in Children with Cerebral Palsy. Journal of Clinical Orthopaedics Jan-Jun 2023;8(1):47-50.

 (Abstract  Full Text HTML)   (Download PDF)