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Bisphosphonate-Induced Atypical Femoral Fractures: Pathogenesis Insights and the Role of Bioactive Collagen Peptides – A Case Report

December 10, 2024/in For New site, Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.690

Open Access License: CC BY-NC 4.0

Submitted Date: 10 Aug 2024, Review Date: 12 Sep 2024, Accepted Date: 15 Sep 2024 & Published Date: 10 Dec 2024

Author: Somasekhara Reddy Nallamilli [1], Mohan Krishna Althuri [1], Shruti Patwal [2], Manish R Garg [3]

[1] Department of Orthopedics, Apollo Hospitals, Hyderabad, Telangana, India,
[2] Department of Medical Affairs, Universal NutriScience, Mumbai, Maharashtra, India,
[3] Department of Medical Affairs, Universal NutriScience, Pharmacology, Mumbai, Maharashtra, India

Address of Correspondence

Dr. Manish R Garg,
Department of Medical Affairs, Universal NutriScience, Pharmacology, Mumbai, Maharashtra, India
E-mail: manish_rgarg@yahoo.co.in

Abstract

Introduction: Bisphosphonates (BPs) have emerged as the mainstay of osteoporosis treatment. However, over the past 10 years, atypical femoral fractures (AFFs) have been identified as a possible side effect of BP.

Case Report: A 73-year-old male with a history of prostate carcinoma and an isolated rib metastasis was being treated with zoledronic acid. Despite a successful intramedullary nail fixation and a healed fracture, 5 months later, he developed another fracture in the same femur in the subtrochanteric area. This case report delves into the intricate pathogenesis of BP-induced atypical femoral fractures (AFF) and explores the potential role of bioactive collagen peptides in their pathogenesis.

Conclusion: Significant challenges exist in diagnosing and managing BP-induced AFFs. Using anabolic agents and bioactive collagen peptides is a successful therapeutic intervention for these patients.

Keywords: Collagen peptides, nutraceuticals, osteoporosis, bisphosphonate-induced atypical fractures.

References

1. Black DM, Geiger EJ, Eastell R, Vittinghoff E, Li BH, Ryan DS, et al. Atypical femur fracture risk versus fragility fracture prevention with bisphosphonates. N Engl J Med 2020;383:743-53.
2. Lindsay R, Cosman F. Osteoporosis. In: Jameson JL, Fauci AS, Kasper DL, Hauser ST, Longo DL, Loscazo J, editors. Harrison’s Principles of Internal Medicine. 20th ed., Vol. 2. New York: McGraw Hill; 2018. p. 2942-59.
3. Rogers MJ, Watts DJ, Russell RG. Overview of bisphosphonates. Cancer 1997;80:1652-60.
4. Ganesan K, Goyal A, Roane D. Bisphosphonate. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2024.
5. Rudran B, Super J, Jandoo R, Babu V, Nathan S, Ibrahim E, et al. Current concepts in the management of bisphosphonate associated atypical femoral fractures. World J Orthop 2021;12:660-71.
6. Tile L, Cheung AM. Atypical femur fractures: Current understanding and approach to management. Ther Adv Musculoskelet Dis 2020;12:1759720X20916983.
7. Larsen MS, Schmal H. The enigma of atypical femoral fractures: A summary of current knowledge. EFORT Open Rev 2018;3:494-500.
8. Githens M, Garner MR, Firoozabadi R. Surgical management of atypical femur fractures associated with bisphosphonate therapy. J Am Acad Orthop Surg 2018;26:864-71.
9. Giusti A, Hamdy NA, Papapoulos SE. Atypical fractures of the femur and bisphosphonate therapy: A systematic review of case/case series studies. Bone 2010;47:169-80.
10. Yoon RS, Beebe KS, Benevenia J. Prophylactic bilateral intramedullary femoral nails for bisphosphonate-associated signs of impending subtrochanteric hip fracture. Orthopedics 2010;33:267-70.
11. Pearce O, Edwards T, Al-Hourani K, Kelly M, Riddick A. Evaluation and management of atypical femoral fractures: An update of current knowledge. Eur J Orthop Surg Traumatol 2021;31:825-40.
12. Liberman UA, Weiss SR, Bröll J, Minne HW, Quan H, Bell NH, et al. Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group. N Engl J Med 1995;333:1437-44.
13. Adam M, Spacek P, Hulejova H, Galianova A, Blahos J. Postmenopausal osteoporosis. Treatment with calcitonin and a diet rich in collagen proteins. Cas Lek Cesk 1996;135:74-8.
14. Im GI, Jeong SH. Pathogenesis, management and prevention of atypical femoral fractures. J Bone Metab 2015;22:1-8.
15. König D, Oesser S, Scharla S, Zdzieblik D, Gollhofer A. Specific collagen peptides improve bone mineral density and bone markers in postmenopausal women-a randomized controlled study. Nutrients 2018;10:97.
16. Schneider JP, Hinshaw WB, Su C, Solow P. Atypical femur fractures: 81 individual personal histories. J Clin Endocrinol Metab 2012;97:4324-8.
17. Lin TL, Wang SJ, Fong YC, Hsu CJ, Hsu HC, Tsai CH. Discontinuation of alendronate and administration of bone-forming agents after surgical nailing may promote union of atypical femoral fractures in patients on long-term alendronate therapy. BMC Res Notes 2013;6:11.
18. Miyakoshi N, Aizawa T, Sasaki S, Ando S, Maekawa S, Aonuma H, et al. Healing of bisphosphonate-associated atypical femoral fractures in patients with osteoporosis: A comparison between treatment with and without teriparatide. J Bone Miner Metab 2014;33:553-9.
19. Gao J, Liu X, Wu X, Li X, Liu J, Li M. A brief review and clinical evidences of teriparatide therapy for atypical femoral fractures associated with long-term bisphosphonate treatment. Front Surg 2023;9:1063170.
20. Zdzieblik D, Oesser S, König D. Specific bioactive collagen peptides in osteopenia and osteoporosis: Long-term observation in postmenopausal women. J Bone Metab 2021;28:207-13.

How to Cite this article: Nallamilli SR, Althuri MK, Patwal S, Garg MR. Bisphosphonate-Induced Atypical Femoral Fractures: Pathogenesis Insights and the Role of Bioactive Collagen Peptides – A Case Report. Journal of Clinical Orthopaedics July-December 2024;9(2):118-122.

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Our Initial Experience of First 50 Cases of Robotic-Arm-Assisted Total Knee Arthroplasty

December 10, 2024/in For New site, Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.662

Open Access License: CC BY-NC 4.0

Submitted Date: 09 Aug 2024, Review Date: 26 Aug 2024, Accepted Date: 17 Sep 2024 & Published Date: 10 Dec 2024

Author: Chandan Mehta [1], Mohan Madhav Desai [1], Swapnil Chitnavis [1], Kushagra Jain [1], Urvil Shah [1]

[1] Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India

Address of Correspondence

Dr. Chandan Mehta,

Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
E-mail: drchandanmehta01@gmail.com

Abstract

Purpose: Robotic-arm-assisted total knee arthroplasty (RA-TKA) has been criticized for an increased operative time, longer incision, the extra incision for insertion of pins and various other potential complications. We want to describe our initial experience of the first 50 cases of RA-TKA (of fully automatic robot) regarding the learning curve for operative time, accuracy of implant positioning, and the accuracy of achieving a well-balanced knee through the assessment of gaps.
Materials and Methods: Retrospective analysis of the first 50 patients was done who underwent RA-TKA, all of which were performed by a senior surgeon experienced in conventional manual jig-based TKA. Operative time, accuracy of implant positing, restoration of limb alignment, and intraoperative gap balancing were assessed. Linear regression analysis and cumulative sum (CUSUM) sequential analysis were used to assess the learning curve for the operative time.
Results: In our experience, the learning curve for operative time in RA-TKA is around 25 cases as per CUSUM sequential analysis. The linear regression analysis showed a gradual decrease in the operative time as the number of RA-TKA performed cases increased (cases 1–10 = 76.8 ± 16 min, cases 11–20 = 72.5 ± 13 min, cases 21–30 = 63.6 ± 7 min, cases 31–40 = 61.3 ± 6 min, and cases 41–50 = 57.3 ± 10 min) – statically significant (P < 0.05) after 20 cases. There is no learning curve for the accuracy of achieving the planned implant position (P = n.s.) and limb alignment (P = n.s.). Only three cases were outliers, HKA angle <174° for varus phenotype, and HKA >183° for valgus phenotype. Forty-six cases (out of 50) had all the gaps within 3 mm of each other (sensitivity of the robot is <1 mm).
Conclusion: Implementation of RA-TKA into the surgical workflow is associated with a learning curve for the operative times, which eventually decreases but this does not lead to any compromise in the accuracy of implant positioning or overall limb alignment. The RA-TKA has shown improved accuracy in implant positioning, improved limb alignment, thereby reducing outliers, and improved gap balancing. All this translates to better clinical outcomes and patient satisfaction.
Keywords: Robotic arm assisted Total Knee Arthroplasty, Learning Curve, Operative time, Implant Positioning, Gap Balancing

References

1. Bourne RB, Chesworth BM, Davis AM, Mahomed NN, Charron KD. Patient satisfaction after total knee arthroplasty: Who is satisfied and who is not? Clin Orthop Relat Res 2010;468:57-63.
2. Bautista M, Manrique J, Hozack WJ. Robotics in total knee arthroplasty. J Knee Surg 2019;32:600-6.
3. Hampp EL, Chughtai M, Scholl LY, Sodhi N, Bhowmik-Stoker M, Jacofsky DJ, et al. Robotic-arm assisted total knee arthroplasty demonstrated greater accuracy and precision to plan compared with manual techniques. J Knee Surg 2019;32:239-50.
4. Bellemans J, Vandenneucker H, Vanlauwe J. Robot-assisted total knee arthroplasty. Clin Orthop Relat Res 2007;464:111-6.
5. Moon YW, Ha CW, Do KH, Kim CY, Han JH, Na SE, et al. Comparison of robot-assisted and conventional total knee arthroplasty: A controlled cadaver study using multiparameter quantitative three-dimensional CT assessment of alignment. Comput Aided Surg 2012;17:86-95.
6. Liow MH, Chin PL, Tay KJ, Chia SL, Lo NN, Yeo SJ. Early experiences with robot-assisted total knee arthroplasty using the DigiMatch™ ROBODOC® surgical system. Singapore Med J 2014;55:529-34.
7. Shatrov J, Battelier C, Sappey-Marinier E, Gunst S, Servien E, Lustig S. Functional alignment philosophy in total knee arthroplasty – rationale and technique for the varus morphotype using a CT based robotic platform and individualized planning. SICOT J 2022;8:11.
8. Shatrov J, Foissey C, Kafelov M, Batailler C, Gunst S, Servien E, et al. Functional alignment philosophy in total knee arthroplasty-rationale and technique for the valgus morphotype using an image based robotic platform and individualized planning. J Pers Med 2023;13:212.
9. Sodhi N, Khlopas A, Piuzzi NS, Sultan AA, Marchand RC, Malkani AL, et al. The learning curve associated with robotic total knee arthroplasty. J Knee Surg 2018;31:17-21.
10. Jung HJ, Kang MW, Lee JH, Kim JI. Learning curve of robot-assisted total knee arthroplasty and its effects on implant position in Asian patients: A prospective study. BMC Musculoskelet Disord 2023;24:332.
11. Vermue H, Luyckx T, Winnock de Grave P, Ryckaert A, Cools AS, Himpe N, et al. Robot-assisted total knee arthroplasty is associated with a learning curve for surgical time but not for component alignment, limb alignment and gap balancing. Knee Surg Sports Traumatol Arthrosc 2022;30:593-602.
12. Marchand KB, Ehiorobo J, Mathew KK, Marchand RC, Mont MA. Learning curve of robotic-assisted total knee arthroplasty for a high-volume surgeon. J Knee Surg 2022;35:409-15.
13. Kayani B, Konan S, Huq SS, Tahmassebi J, Haddad FS. Robotic-arm assisted total knee arthroplasty has a learning curve of seven cases for integration into the surgical workflow but no learning curve effect for accuracy of implant positioning. Knee Surg Sports Traumatol Arthrosc 2019;27:1132-41.
14. Khlopas A, Chughtai M, Hampp EL, Scholl LY, Prieto M, Chang TC, et al. Robotic-arm assisted total knee arthroplasty demonstrated soft-tissue protection. Surg Technol Int 2017;30:441-6.
15. Kayani B, Konan S, Peitrzak JR, Haddad FS. Iatrogenic bone and soft tissue trauma in robotic-arm assisted total knee arthroplasty compared with conventional jig-based total knee arthroplasty: A prospective cohort study and validation of a new classification system. J Arthroplasty 2018;33:2496-501.
16. Song EK, Seon JK, Yim JH, Netravali NA, Bargar WL. Robotic-assisted TKA reduces postoperative alignment outliers and improves gap balance compared to conventional TKA. Clin Orthop Relat Res 2013;471:118-26.
17. Ritter MA, Faris PM, Keating EM, Meding JB. Postoperative alignment of total knee replacement. Its effect on survival. Clin Orthop Relat Res 1994;299:153-6.

How to Cite this article: Mehta C, Desai MM, Chitnavis S, Jain K, Shah U. Our Initial Experience of First 50 Cases of Robotic-Arm Assisted Total Knee Arthroplasty. Journal of Clinical Orthopaedics July-December 2024;9(2):47-51.

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Prof Dr K V Chaubal – A Requiem

December 10, 2024/in For New site, Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.642

Open Access License: CC BY-NC 4.0

Author: Aseem Parekh [1]

[1] Consultant Orthopaedic Surgeon, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Aseem Parekh,
Consultant Orthopaedic Surgeon, Mumbai, Maharashtra, India.
E-mail: docaseemparekh@gmail.com

Prof Dr K V Chaubal – A Requiem

“An Institution Is The Lengthened Shadow Of One Man.”

~ Ralph Waldo Emerson

Prof Dr K V Chaubal, “KVC”, cast a very long, and indeed broad, shadow over the world he lived in.

He was an institution in himself.

Over many decades of a busy practice he brought succour to an untold number of patients.
He also contributed to the development and growth of his many students, as also the orthopaedic fraternity of which he was a leader.

KVC was born into a traditional family, where great emphasis was laid on personal discipline, probity and education.

After his Intermediate Science from the Elphinstone College, he gained entry into the prestigious Seth G S Medical College in 1945.
He gained his MS in general surgery and then left for England, and found himself in a country which was in its post war decade of austerity.
He trained with giant figures in the fields of surgery and orthopaedics, and impressed his teachers with his intelligence and diligence. Mr Harold Bolton and Sir Lloyd Griffiths were but two of them, the latter provided him with a glowing testimonial when KVC moved to Liverpool for his MCh Orth.
He remembered and was ever grateful to his teachers.
His training culminated with his gaining the FRCS(Eng) and the MCh Orth. (L’pool).

On his return to India he was appointed Asst Hon Surgeon to the St George’s Hospital, an event he described as a windfall, for
there he learned much about what is now called “networking” and dealing with persons in high office.
He was selected for a J&J fellowship which enabled him to travel across India and he decided to become a “generalist” practitioner of his craft.

Shortly thereafter he was appointed to the staff of Nair Hospital, where he soon became Chief and set about developing the department in his now trademark meticulous way.

Laurels ensued, and he wore his honours lightly.
With each accomplishment, his fame spread.
He was soon regarded as an authority in his subject, especially the treatment of spinal ailments.

He was a spartan, austere figure, always immaculately turned out and speaking always to the point, softly but always firmly.

He suffered fools not at all, and to many he appeared aloof, even distant.
Indeed, such was his focus that unless you were participating productively you rapidly felt like a piece of furniture in the room.
Yet a colleague, even a rank junior, who approached him with a problem of any magnitude or nature was assured of a sympathetic hearing and invariably got a solution to the predicament posed.

KVC had well settled ideas on all subjects.

And the views he held were considered over years of wide reading, personal experience and a vast understanding of human nature.
He rose to the front rank of the profession, an authority, a visionary and an opinion maker.

His dedication to personal probity and integrity led him to evolve as the final arbiter on all issues related to professional and personal ethics.
He practised what he preached, a rare phenomenon.

He was fully comprehending of the follies and foibles of others, but he never lost his compassion for them.
He was something of a paradox, in that he was at the same time inflexible yet remarkably open to new thought.
He considered everything before altering his stand, and if he did he stood committed to it.

Yes, he was a paragon, a man of many parts, and yet the sum of these was not greater than the whole.

An ethical man, a brilliant teacher an erudite academic and a skilful surgeon.. we will not see the like of him again.

Prof. Dr. Aseem Parekh
Consultant Orthopaedic Surgeon,
Mumbai, India.
Email: docaseemparekh@gmail.com

How to Cite this article: Parekh A. Prof Dr K V Chaubal- A Requiem. Journal of Clinical Orthopaedics July-December 2024;9(2):06-07.

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Use of Skeletal Traction in Distal 1/3rd Tibia Intraoperatively for Achieving Reduction in Proximal Tibia Fracture

December 10, 2024/in For New site, Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.674

Open Access License: CC BY-NC 4.0

Submitted Date: 02 Oct 2024, Review Date: 28 Oct 2024, Accepted Date: 01 Nov 2024 & Published Date: 10 Dec 2024

Author: Rajendraprasad Ramesh Butala [1], Sonali Das [1], Garvit Khatod [1]

[1] Department of Orthopaedics, DY Patil Hospital, Navi Mumbai, Maharashtra, India.

Address of Correspondence

Sonali Das,
Department of Orthopaedics, DY Patil Hospital, Navi Mumbai, Maharshtra, India.
Email: drsonalidas@hotmail.com

Abstract

Introduction: Skeletal traction is a technique used to manage fractures by applying continuous axial force directly to the bone through a pin inserted through it. This method is particularly useful in maintaining proper alignment of fracture fragments, reducing pain, and preventing muscle spasms. It is commonly employed in the management of long bone fractures, such as those of the femur, especially when immediate surgical intervention is not possible. Skeletal traction stabilizes the fracture, facilitating proper healing and often serving as a temporizing measure before definitive surgical fixation. This study focuses on skeletal traction applied for the reduction of proximal tibia fractures. Studies on this subject are lacking as most established data focuses on its use for shaft femur fractures.
Materials and Methods: This study was conducted in a tertiary care teaching hospital by a single skilled surgeon team on 30 skeletally mature patients. Skeletal traction was applied for each patient using a Steinmann pin and 15% of the patient body weight over distal 1/3rd tibia shaft immediately post-trauma for 1 week and continued intraoperatively during primary fixation as plating. Pre-operative and post-operative radiographs were taken. Knee range of motion was measured using a goniometer at 2 weeks, 1 month, 3 months, and 6 months post-operative. Serial radiographs were taken immediately, 1 month, 3 months, and 6 months post-operative.
Conclusion: Skeletal traction applied over the distal 1/3rd shaft tibia shows promising results for comminuted proximal tibia fractures. It reduces fracture fragment displacement commonly occurring during manual traction.
Keywords: Skeletal traction, Proximal tibia, Tibial fractures, Lower extremity trauma.

References

1. Elsoe R, Johansen MB, Larsen P. Tibial plateau fractures are associated with a long-lasting increased risk of total knee arthroplasty a matched cohort study of 7,950 tibial plateau fractures. Osteoarthritis Cartilage 2019;27:805-9.
2. Dendrinos GK, Kontos S, Katsenis D, Dalas A. Treatment of high-energy tibial plateau fractures by the Ilizarov circular fixator. J Bone Joint Surg Br 1996;78:710-7.
3. Young MJ, Barrack RL. Complications of internal fixation of tibial plateau fractures. Orthop Rev 1994;23:149-54.
4. Skin Traction and Skeletal Traction. Bone and Spine. 2019.
5. Matullo KS, Gangavalli A, Nwachuku C. Review of lower extremity traction in current orthopaedic trauma. J Am Acad Orthop Surg 2016;24:600-6.
6. Stephen DJ, Kreder HJ, Schemitsch EH, Conlan LB, Wild L, McKee MD. Femoral intramedullary nailing: Comparison of fracture-table and manual traction. A prospective, randomized study. J Bone Joint Surg Am 2002;84:1514-21.
7. Menghi A, Mazzitelli G, Marzetti E, Barberio F, D’Angelo E, Maccauro G. Complex tibial plateau fractures: A retrospective study and proposal of treatment algorithm. Injury 2017;48 Suppl 3:S1-6.
8. Krieg JC. Proximal tibial fractures: Current treatment, results, and problems. Injury 2003;34:A2-10.
9. Hu SJ, Chang SM, Zhang YQ, Ma Z, Du SC, Zhang K. The anterolateral supra-fibular-head approach for plating posterolateral tibial plateau fractures: A novel surgical technique. Injury 2016;47:502-7.
10. Hu S, Chen S, Chang S, Xiong W, Tuladhar R. Treatment of isolated posterolateral tibial plateau fracture with a horizontal belt plate through the anterolateral supra-fibular-head approach. Biomed Res Int 2020;2020:4186712.
11. Schneiderman BA, O’Toole RV. Compartment syndrome in high-energy tibial plateau fractures. Orthop Clin North Am 2022;53:43-50.
12. Hak DJ, Lee M, Gotham DR. Influence of prior fasciotomy on infection after open reduction and internal fixation of tibial plateau fractures. J Trauma 2010;69:886-8.
13. Dubina AG, Paryavi E, Manson TT, Allmon C, O’Toole RV. Surgical site infection in tibial plateau fractures with ipsilateral compartment syndrome. Injury 2017;48:495-500.
14. Paziuk T, Sutton R, McEntee R, Farronato D, Krieg J. Lateral femoral distraction is a safe and necessary adjunct for articulator visualization during the operative treatment of tibial plateau fractures. J Orthop 2022;33:44-7.
15. Wang Z, Lu Y, Wang Q, Song L, Ma T, Ren C, et al. Comparison of the effectiveness and safety of intravenous and topical regimens of tranexamic acid in complex tibial plateau fracture: A retrospective study. BMC Musculoskelet Disord 2020;21:739.

How to Cite this article: Butala RR, Das S, Khatod G. Use of Skeletal Traction in Distal 1/3rd Tibia Intraoperatively for Achieving Reduction in Proximal Tibia Fracture. Journal of Clinical Orthopaedics 2024:July-December:9(2);78-82.

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A Novel Approach to Medial Malleolus Fracture of Ankle using Adjustable Loop Suspensory Fixation

December 10, 2024/in For New site, Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.698

Open Access License: CC BY-NC 4.0

Submitted Date: 29 Jul 2024, Review Date: 15 Aug 2024, Accepted Date: 18 Sep 2024 & Published Date: 10 Dec 2024

Author: Sandeep Deore [1], Sachin Kale [1], Sunil Shetty [1], Ajit Chalak [2], Rohan Jayaram [1], Roonam Patir [1]

[1] Department of Orthopaedics, Dr. D.Y. Patil Medical College and Hospital, Navi Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, MGM Medical College, Navi Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Rohan Jayaram,
Department of Orthopaedics, Dr. D.Y. Patil Medical College and Hospital, Navi Mumbai, Maharashtra, India.
E-mail: drrohanjayaram@gmail.com

Abstract

Medial malleolar fractures are traditionally treated by orthopaedic surgeons using cancellous screws, plates, and tension banding with stainless steel wires. However, a considerable proportion of these patients eventually require revision surgery or implant removal due to complications such as wire migration, impingement, breakage, and infection. Revision surgeries for previously operated malleolar fractures pose challenges due to dilated bone tracks and osteopenia which complicate securing the mechanical hold of the implant. A potential solution to mitigating these factors could be the use of high strength polyethylene suture material such as fibre-wire to fix the fracture fragments which are held in place by a cortical button on either side. This study aims to evaluate the clinical and radiological outcomes in a patient with medial malleolus fracture fixed by fibre-wire fixation as an alternative modality of treatment.
Keywords: Medial malleolar fractures, tension band principle, stainless steel wire, implant breakage, revision surgery, suspensory fixation using fiber-wire, magnetic resonance imaging compatible construct.

References

1. Ostrum RF, Litsky AS. Tension band fixation of medial malleolus fractures. J Orthop Trauma 1992;6:464–468
2. Carter TH, Duckworth AD, White TO. Medial malleolar fractures: current treatment concepts. J Bone Joint Surg [Br] 2019;101-B:512–521
3. Skie MC, Ebraheim NA, Woldenberg L, Randall K. Fracture of the anterior colliculus. J Trauma. 1995;38(4):642-7
4. Mast JW, Teipner WA. A reproducible approach to the internal fixation of adult ankle fractures: rationale, technique, and early results. Orthop Clin North Am. 1980;11(3):661-79
5. S. Nayagam, Safe corridors in external fixation: the lower leg (tibia, fibula, hindfoot and forefoot), Strategies Trauma Limb Reconstr. 2 (2-3) (2007) 105–110, https://doi.org/10.1007/s11751-007-0023-7
6. Elsoe R, Ostgaard SE, Larsen P. Population-based epidemiology of 9767 ankle fractures. Foot Ankle Surg 2018;24:34–39.
7.Thur CK, Edgren G, Jansson K-Å, Wretenberg P. Epidemiology of adult ankle fractures in between 1987 and 2004. Acta Orthop 2012;83:276–281.
8. Georgiadis GM, White DB. Modified tension band wiring of medial malleolar ankle fractures. Foot Ankle Int. 1995 Feb;16(2):64-8. doi: 10.1177/107110079501600202. PMID: 7767448.
9. Fowler TT, Pugh KJ, Litsky AS, Taylor BC, French BG. Medial malleolar fractures: a biomechanical study of fixation techniques. Orthopedics. 2011 Aug 8;34(8):e349-55. doi:
10.3928/01477447-20110627-09. PMID: 21815575.
10. Downey MW, Duncan K, Kosmopoulos V, Motley TA, Carpenter BB, Ogunyankin F, Garrett A. Comparing the Knotless Tension Band and the Traditional Stainless Steel Wire Tension Band Fixation for Medial Malleolus Fractures: A Retrospective Clinical Study. Scientifica (Cairo). 2016;2016:3201678. doi: 10.1155/2016/3201678. Epub 2016 May 12. PMID: 27293969; PMCID: PMC4880701.
11. Kochai A, Türker M, Çiçekli Ö, Özdemir U, Bayam L, Erkorkmaz Ü, Şükür E. A comparative study of three commonly used fixation techniques for isolated medial malleolus fracture. Eklem Hastalik Cerrahisi. 2018 Aug;29(2):104-9. doi: 10.5606/ehc.2018.61449. PMID: 30016610.
12. Dy CJ, Little MT, Berkes MB, Ma Y, Roberts TR, Helfet DL, Lorich DG. Meta-analysis of re-operation, nonunion, and infection after open reduction and internal fxation of patella fractures. J Trauma Acute Care Surg. 2012;73(4):928–32. https://doi.org/10. 1097/TA.0b013e31825168b6.
13. Jirangkul, P., Kosiyatrakul, A. Abstaining from symptomatic implants of modified tension band wiring by nonabsorbable suture fixation for transverse patella fractures. J Orthop Surg Res 16, 367 (2021). https://doi.org/10.1186/s13018-021-02494-3
14. Weber MJ, Janecki CJ, McLeod P, Nelson CL, Thompson JA. Efficacy of various forms of fixation of transverse fractures of the patella. J Bone Joint Surg Am. 1980;62(2):21520. https://doi.org/10.2106/00004623-198062020-00007.

How to Cite this article: Deore S, Kale S, Shetty S, Chalak A, Jayaram R, Patir R. A Novel Approach to Medial Malleolus Fracture of Ankle using Adjustable Loop Suspensory Fixation. Journal of Clinical Orthopaedics July-December 2024;9(2):132-136.

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Relation of Femur Neck Shaft Angle with Hip Fractures: An Observational Retrospective Study

December 10, 2024/in For New site, Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.670

Open Access License: CC BY-NC 4.0

Submitted Date: 10 Aug 2024, Review Date: 22 Aug 2024, Accepted Date: 17 Sep 2024 & Published Date: 10 Dec 2024

Author: Rajendraprasad Ramesh Butala [1], Sonali Das [1]

[1] Department of Orthopaedics, DY Patil Hospital, Navi Mumbai, Maharashtra, India.

Address of Correspondence

Sonali Das,
Department of Orthopaedics, DY Patil Hospital, Navi Mumbai, Maharshtra, India.
Email: drsonalidas@hotmail.com

Abstract

Introduction: Hip fractures are one of the most common fractures in adults encountered in orthopedics, posing a great deal of risk to patients’ life. Hip fractures include subtrochanteric, intertrochanteric, and femoral neck fractures. The proximal femur’s geometry has drawn more attention recently in relation to the etiology of hip fractures. Higher femoral neck-shaft angles (FNSAs) have been implicated in a predisposition to hip fractures.
Materials and Methods: A cross-sectional comparative study conducted at a tertiary care center in western part of India. Two groups of 50 individuals each created, matched for age range and gender, one control and the other with unilateral hip fracture.
Results: On conducting a binary logistic regression with absence or presence of fracture being the dependent variable and FNSA being covariate, an Odd’s ratio of >1 identified, indicating the likelihood of higher FNSA values seen in fracture group than in control group. P value also found to be <0.05 hence significant. No significant difference was noted between the FNSA of males and female patients in fracture group. FNSA was higher in fracture group than in control group, mean FNSA 136.8 and 132.3°, respectively. We have noted an increased risk of hip fractures in patients with higher FNSA matched with their age and gender. This is confirmative of the findings noted in previous studies.
Conclusion: Hip fracture risk appears to be increased in those with higher FNSA. Although the precise cutoff value is yet unknown, this link could serve as the foundation for prevention in individuals whose values are high – that is, >136° – according to this study. Further, evaluation is needed for conclusive understanding of their relationship.
Keywords: Femur neck shaft angle, Hip fractures, Relative risk.

References

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How to Cite this article: Butala RR, Das S. Relation of femur neck shaft angle with hip fractures: An observational retrospective study. Journal of Clinical Orthopaedics 2024:July-December:9(2)67-71.

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Patellar Resurfacing vs. Non-resurfacing in Total Knee Arthroplasty: A Review of Pain and Function

December 10, 2024/in For New site, Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.672

Open Access License: CC BY-NC 4.0

Submitted Date: 05 Sep 2024, Review Date: 10 Oct 2024, Accepted Date: 12 OCt 2024 & Published Date: 10 Dec 2024

Author: Aashay Sonkusale [1], Ashish Phadnis [2]

[1] Department of Arthroplasty and Arthroscopy, Apollo Hospital Chennai, Tamil Nadu, India.
[2] Department of Orthopaedics, Jupiter Hospital, Thane, Maharashtra, India.

Address of Correspondence

Dr. Aashay Sonkusale,
Fellow in Arthroplasty and Arthroscopy, Apollo Hospital Chennai, Tamil Nadu, India.
E-mail: sonkusaleaashay614@gmail.com

Abstract

Patella resurfacing in total knee arthroplasty has always been a topic of debate among the orthopedic surgeons around the world since its introduction in 1975 by Insall-Burstein. The results of current technique of PR has the promise lesser re-operations rates and cost-effectiveness in the long run, it is not albeit complications such as fracture, overstuffing of the patellofemoral joint, and maltracking of patella. Recent patella-friendly implants such as single radius anatomic femoral component and medial pivot knee have better patellar kinematic profiles with a deeper trochlear groove, a lateralized trochlear axis in the sagittal plane improving patellar contact force distribution. This has reduced the incidence of anterior knee pain following TKA, although there are other causes which have to be borne in mind when dealing with post-TKA AKP. Non-resurfacing of patella although claim to have similar patient-related outcome measures in the long run, lower patient satisfaction, and anterior knee pain have been deterrents to its absolute acceptance. Other methods such as cautery denervation (CD) and patelloplasty also boast functional outcomes similar to resurfacing with the advantages of being time effectivity, easy, and safe. There is considerable non-uniformity with these non-resurfacing techniques, depending on the surgeon’s preference and training. Selective resurfacing in “at-risk patellae” identified by pre- and intra-operative characteristics is increasing gaining popularity. We undertake a narrative review of the resurfacing of the patella focusing on anterior knee pain and functional outcomes.
Keywords: Patellar resurfacing, non-resurfacing, selective re-surfaces, anterior knee pain, knee society score.

References

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How to Cite this article: Sonkusale A, Phadnis A. Patellar Resurfacing vs. Non-resurfacing in Total Knee Arthroplasty: A Review of Pain and Function. Journal of Clinical Orthopaedics July-December 2024;9(2):72-77.

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An Observational Study of Clinical, Radiological, and Functional Outcome in Tibial Plateau Fractures Operated with Open Reduction Internal Fixation in Adults

December 10, 2024/in For New site, Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.664

Open Access License: CC BY-NC 4.0

Submitted Date: 28 Sep 2024, Review Date: 26 Oct 2024, Accepted Date: 02 Nov 2024 & Published Date: 10 Dec 2024

Author: Piyush Madhukar Jadhao [1], Ashish Phadnis [1]

[1] Department of Orthopaedics, Jupiter Hospital – Eastern Express Highway, Thane, Mumbai, Maharashtra, India

Address of Correspondence

Dr. Piyush Madhukar Jadhao,
Senior Registrar, Jupiter Hospital – Eastern Express Highway, Thane, Mumbai, Maharashtra, India.
E-mail: piyushoasis@gmail.com

Abstract

Background: Tibial plateau fractures are among some of the most challenging fractures to treat, associated with a high incidence of posttraumatic osteoarthritis later in life. The most commonly used surgical treatment is open reduction and fixation (ORIF) with plates and screws.
Objectives: This study was conducted to determine the radiological, clinical, and functional outcomes of patients with tibial plateau fractures treated by ORIF.
Materials and Methods: This retroprospective observational study included adult patients operated on for tibial plateau fractures using ORIF. Functional outcome was assessed by patient-reported outcome measures using Short Musculoskeletal Function Assessment, Knee Injury and Osteoarthritis Outcome Score (KOOS), and Short Form-36 Quality of Life questionnaires. Clinical and radiological outcomes were assessed using Modified Rasmussen’s clinical and radiological criteria.
Results: The majority of our patients had type 6 fractures (43.59%). We found a statistically significant negative correlation between the type of fracture and the KOOS total score. Clinical assessment using the Modified Rasmussen Criteria showed excellent results in 33.33% of patients, good results in 51.28% of patients, and fair and poor results in 7.69% of patients each, with an overall satisfactory clinical result in 84.61% of patients. The radiological assessment noted excellent results in 23.08% of patients, good results in 56.41% of patients, fair results in 12.82% of patients, and poor results in 7.69% of patients.
Conclusions: The preferred treatment of choice for tibial plateau fractures is open reduction internal fixation, with most patients demonstrating satisfactory (excellent to good) clinical and radiological outcomes. Operatively treated tibial plateau fractures result in improved functional outcomes, as it offers excellent anatomical reduction and rigid fixation to restore early movement and articular congruity, in addition to preventing stiffness of the knee.
Keywords: Proximal tibia fracture, ORIF, Quality of life, functional outcome, KOOS, SF-36, SMFA.

References

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How to Cite this article: Jadhao PM, Phadnis A. An Observational Study of Clinical, Radiological, and Functional Outcome in Tibial Plateau Fractures Operated with Open Reduction Internal Fixation in Adults. Journal of Clinical Orthopaedics July-December 2024;9(2):52-57.

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Habitual Dislocation of the Patella Managed by a Two-in-One Procedure

December 10, 2024/in For New site, Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.668

Open Access License: CC BY-NC 4.0

Submitted Date: 13 Jul 2024, Review Date: 18 Aug 2024, Accepted Date: 15 Sep 2024 & Published Date: 10 Dec 2024

Author: Ravi Mittal [1], M L V Sai Krishna [2]

[1] Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India,
[2] Department of Orthopaedics, Aayush Hospitals, Eluru, Andhra Pradesh, India

Address of Correspondence

M L V Sai Krishna,
Department of Orthopaedics, Aayush Hospitals, Eluru, Andhra Pradesh, India.
E-mail: krishna.mlv.sai@gmail.com

Abstract

Introduction: Habitual dislocation of the patella is a complex pathological condition of the patella which is characterized by lateral dislocation of the patella with flexion and relocation of the same with extension of the knee. There are numerous surgical procedures with various modifications that have been described in the literature based on the origin of pathology (soft tissue or bone). In this case series of 15 children, we described our technique of two-in-one procedure.
Materials and Methods: We included 15 patients with habitual dislocation of the patella between the ages of 5 and 9 years. In all the patients a detailed evaluation was done preoperatively and all of them were managed by a two-in-one procedure and followed up at 3 months and 1 year.
Results: There was no recurrence of dislocation in any of the patients and all the patients had attained their full range of movement by 1 year.
Conclusion: The two-in-one procedure is a simple and reproducible procedure for the treatment of habitual dislocation of the patella without any bony involvement. The procedure included graded lateral soft-tissue release and the Roux Goldthwait procedure. The amount of lateral soft-tissue release required is titrated intraoperatively.
Keywords: Habitual dislocation, Patella, Two in procedure, Knee.

References

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How to Cite this article: Mittal R, Sai Krishna MLV. Habitual Dislocation of the Patella Managed by a Two-in-One Procedure. Journal of Clinical Orthopaedics 2024:July-December:9(2)63-66.

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Pediatric and Adolescent Ankle Fractures: Current Concepts and Advances in Management

December 10, 2024/in For New site, Vol 9 | Issue 2 | July - Dec 2024 /by editor.jcorth

DOI: https://doi.org/10.13107/jcorth.2024.v09i02.660

Open Access License: CC BY-NC 4.0

Submitted Date: 25 Aug 2024, Review Date: 12 Sep 2024, Accepted Date: 16 Sep 2024 & Published Date: 10 Dec 2024

Author: Swapnil M. Keny [1, 2, 3]

[1] Department of Orthopaedics, K. B. Bhabha Hospital, Bandra, Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, Sir H. N. Reliance Hospital, Mumbai, Maharashtra, India
[3] Department of Orthopaedics, Apollo Hospital, Navi Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Swapnil M. Keny,
Consultant Pediatric Orthopaedic Surgeon, K. B. Bhabha Hospital, Mumbai, Sir H. N. Reliance Hospital, Mumbai, Apollo Hospital, Navi Mumbai, Maharashtra, India.
E-mail: peadortho@gmail.com

Abstract

Pediatric and adolescent ankle fractures are frequently encountered injuries, often involving the distal tibial growth plate and requiring special management due to the potential for growth disturbances. Recent developments in imaging, surgical techniques, and rehabilitation have significantly improved outcomes. This review highlights contemporary practices in the diagnosis and treatment of ankle fractures in younger patients, with a focus on advances in diagnostic tools, operative management, and individualized care. It also explores the integration of new technologies, such as 3D printing and artificial intelligence, in fracture planning and management, reflecting the current standard of care.
Keywords: Pediatric, ankle fractures, distal tibial physeal injuries, Salter-Harris injuries, internal fixation, decision making.

References

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How to Cite this article: Keny SM. Pediatric and Adolescent Ankle Fractures: Current Concepts and Advances in Management. Journal of Clinical Orthopaedics July-December 2024;9(2):44-46.

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Author: Somasekhara Reddy Nallamilli [1], Mohan Krishna Althuri [1], Shruti Patwal [2], Manish R Garg [3]

Abstract

References

Author: Chandan Mehta [1], Mohan Madhav Desai [1], Swapnil Chitnavis [1], Kushagra Jain [1], Urvil Shah [1]

Abstract

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Author: Aseem Parekh [1]

Author: Rajendraprasad Ramesh Butala [1], Sonali Das [1], Garvit Khatod [1]

Abstract

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Author: Sandeep Deore [1], Sachin Kale [1], Sunil Shetty [1], Ajit Chalak [2], Rohan Jayaram [1], Roonam Patir [1]

Abstract

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Author: Rajendraprasad Ramesh Butala [1], Sonali Das [1]

Abstract

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Author: Aashay Sonkusale [1], Ashish Phadnis [2]

Abstract

References

Author: Piyush Madhukar Jadhao [1], Ashish Phadnis [1]

Abstract

References

Author: Ravi Mittal [1], M L V Sai Krishna [2]

Abstract

References

Author: Swapnil M. Keny [1, 2, 3]

Abstract

References

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Journal of Clinical Orthopaedics Details

Journal of Clinical Orthopaedics