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Comparative Study of BMD in Type 2 Diabetic and Non-diabetic Male Patients

June 30, 2024/in For New site, Vol 9 | Issue 1 | Jan-June 2024 /by editor.jcorth

Open Access License: CC BY-NC 4.0

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.628

Author: Jata Shankar Kumar [1], Mohd Danish [1], Vikash Singh [1]

[1] Department of Orthopedics, Max Superspeciality Hospital, Ghaziabad, Uttar Pradesh, India.

Address of Correspondence
Dr. Mohd Danish,
Department of Orthopedics, Max Superspeciality Hospital, Ghaziabad, Uttar Pradesh, India.
E-mail: danish.shan@gmail.com

Abstract

Introduction: Osteoporosis and diabetes are both common human diseases. The prevalence of both is increasing individually and in combination, due to better detection methods and changing definitions. Due to the different pathogenesis of Type 1 and Type 2 diabetes mellitus (T2DM), one of which is a predominant autoimmune process while the other mainly a metabolic disorder, it is not surprising that there is no uniform entity of diabetic bone disease as such, although such term has been proposed in the past but never gained momentum. Paradoxically, an increased risk of osteoporotic fracture in T2DM has been repeatedly demonstrated and this was independent of bone mineral density (BMD). This association with fracture adds uncertainty around the actual association between diabetes mellitus and BMD.
This study aims to study the population of diabetes at tertiary care center when they are compared with non-diabetics in terms of BMD.
Aims of Study: The aim of this study was to determine the prevalence of osteopenia and osteoporosis in T2DM and non-diabetic male patients using Dual Energy X-ray absorptiometry (DEXA scan).
Materials and Methods: Patients for the study included male patients between 40 and 60 years of age group attending outpatient department, health checkup, and admitted in the ward of Saifee Hospital, Department of Medicine. In 200 (100 type 2 diabetic males and 100 non-diabetic males), DEXA Scan was performed in the Department of Imaging, Saifee Hospital from June 2017 to April 2019.
Results: Type 2 diabetics were significantly associated with the presence of osteoporosis compared to non-diabetics (P = 0.001). Type 2 diabetics were significantly associated with body mass index (BMI) >25 (P = 0.0) and diabetics had a significantly higher BMI compared to non-diabetics (P = 0.0001). Type 2 diabetics above 50 years of age were significantly associated with osteoporosis (P = 0.000) and diabetics with osteoporosis were significantly older compared to diabetics without osteoporosis (P = 0.0018).
Conclusion: The study concluded that there is a correlation between T2DM, increasing age, glycemic control, increased BMI, increased calcium levels, and decreased BMD. Thus, physician treating diabetes must anticipate decreased BMD and rule out or correct all of these factors in patients of diabetes to prevent the complications of decreased BMD in these groups of patients. Therefore, early detection and treatment of osteoporosis/osteopenia by estimation of BMD in Type 2 diabetic males, strict diabetic control with target hemoglobin A1c <6.5, weight control with target BMI <25, supplementation with Vitamin D3 should be advocated.
Keywords: Diabetes, osteoporosis, dual-energy X-ray absorptiometry scan.

References

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How to Cite this article: Kumar JS, Danish M, Singh V. Comparative Study of BMD in Type 2 Diabetic and Non-diabetic Male Patients. Journal of Clinical Orthopaedics 2024 January-June;9(1):28-34.

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Potpourri – Recent and Relevant Literature in Periprosthetic Fractures Around the Knee

June 30, 2024/in For New site, Vol 9 | Issue 1 | Jan-June 2024 /by editor.jcorth

Open Access License: CC BY-NC 4.0

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.634

Author: Clevio Desouza [1, 2], Nicholas Antao [2]

[1] Centre for Bone and Joints, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India,
[2] Department of Orthopaedics, Holy Spirit Hospital, Andheri, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Clevio Joao Baptista Desouza,
Centre for Bone and Joints, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India.
E-mail: ceviod@gmail.com

Abstract

Knee replacement stands as an effective treatment for alleviating pain and restoring function in cases of degenerative joint conditions. The escalating prevalence of knee replacements reflects their acknowledged success. Despite being a relatively uncommon complication, periprosthetic fractures surrounding total knee arthroplasties present intricate challenges, demanding proficiency in both arthroplasty and trauma reconstructive techniques from treating surgeons. The confluence of increased life expectancy and elevated functional expectations among elderly individuals may contribute to a heightened occurrence of periprosthetic fractures. Among these fractures, supracondylar fractures of the femur emerge as the most prevalent. This comprehensive review delves into the classification and diverse treatment modalities available for addressing periprosthetic fractures around total knee arthroplasties.
Keywords: Total Knee Arthroplasty, Replacement, Femur, Periprosthetic fractures

References

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14. Antao NA, Londhe S, Toor R, Shirishkar R, Aiyer S. Short-term results of a novel management of supracondylar fracture with coexisting osteoarthritis with bifold fixation and total knee arthroplasty. Arthroplasty. 2021 Dec 4;3(1):44.
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16. Norrish AR, Jibri ZA, Hopgood P. The LISS plate treatment of supracondylar fractures above a total knee replacement: A case-control study. Acta Orthop Belg 2009;75:642-8.
17. Ebraheim NA, Sochacki KR, Liu X, Hirschfield G, Liu J. Locking plate fixation of periprosthetic femur fractures with and without cerclage wires. Orthop Surg 2013;5:183-7.
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How to Cite this article: Desouza C, Antao N. Potpourri – Recent and Relevant Literature in Periprosthetic Fractures Around the Knee. Journal of Clinical Orthopaedics 2024;January-June:9(1):52-56.

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Infection After Total Knee Arthroplasty: Does Timing of Pre-operative Antibiotics Matter?

June 30, 2024/in For New site, Vol 9 | Issue 1 | Jan-June 2024 /by editor.jcorth

Open Access License: CC BY-NC 4.0

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.624

Author: Timothy J Walden [1,2,3], Max L Willinger [1,2,3], Jamie C Heimroth [1,2,3], Adam Strigenz2, Alain Sherman [1], Jonathan R Danoff [1,2,3]

[1] Northwell Orthopedics, New Hyde Park, New York, USA,
[2] North Shore University Hospital, New York, USA,
[3] Zucker School of Medicine, Hempstead, New York, USA.

Address of Correspondence

Dr. Jonathan R. Danoff,
270-05 76th Ave, New Hyde Park, NY 11040,
E-mail: jdanoff@northwell.edu

Abstract

Background: Since the 2003 NIH consensus statement, the use of prophylactic antibiotics in total knee arthroplasty (TKA) has been the standard of care. Some studies recommend antibiotic administration within 1 h of skin incision, but no specific time frame has been delineated. The objective of this study was to determine if timing of pre-operative antibiotics is associated with post-operative infection after TKA.
Materials and Methods: An institutional database from a multi-center health-care system was queried with ICD-10 codes and reviewed for patients undergoing primary TKA between March 2020 and December 2020. The rate of superficial surgical site infection (SSI) and periprosthetic joint infection (PJI) was compared with pre-operative antibiotic timing. PJIs were defined based on 2018 MSIS criteria and superficial SSIs were other infections that did not meet MSIS criteria. Antibiotic timing was separated into 15-min cohorts from 0 min before skin incision to over 45 min before incision. Further comparison between patients who received antibiotics within 30 min of incision with those who received antibiotics greater than 30 min prior was performed.
Results: Of the 2511 patients who underwent primary TKA, 19 were found to have post-operative infections. There were 7 SSIs, and 12 PJIs, 16 of the post-operative infections occurred when patients received antibiotics <30 min before incision. There was no significant difference in SSIs or PJIs between each 15-min time interval of antibiotic administration (P = 0.45) or between the 30-min time intervals (P = 0.09).
Conclusion: Our study demonstrates no difference in post-operative infection based on pre-operative antibiotic timing. As long as antibiotics are given within 60 min of incision, preferentially 30–60 min before incision, their timing does not have a significant effect on post-operative infection following TKA.
Keywords: Pre-operative antibiotics, periprosthetic joint infection, superficial skin infection, total knee arthroplasty, complications

References

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How to Cite this article: Walden TJ, Willinger ML, Heimroth JC, Strigenz A, Sherman A, Danoff JR. Infection After Total Knee Arthroplasty: Does Timing of Pre-operative Antibiotics Matter? Journal of Clinical Orthopaedics 2024;January-June:9(1):17-21.

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Functional Outcome of Distal Humerus Intra-articular Fractures Treated with Pre-contoured Anatomical Locking Plates

June 30, 2024/in For New site, Vol 9 | Issue 1 | Jan-June 2024 /by editor.jcorth

Open Access License: CC BY-NC 4.0

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.622

Author: Swapnil Chitnavis [1]

[1] Department of Orthopedics, Seth G. S. Medical College & K. E. M. Hospital, Parel, Maharashtra, India

Address of Correspondence

Dr. Swapnil Chitnavis,
Department of Orthopaedics, Seth G. S. Medical College & K. E. M. Hospital, Parel, Mumbai, India.
Email – swapnilchitnavis@gmail.com

Abstract

Introduction: The most difficult therapeutic challenge is treating humerus fractures, which might result in a subpar functional outcome. It is anticipated that early mobilization, anatomic reduction, and internal fixation will enhance the functional results. The purpose of this study is to assess the functional result, intercondylar fixation rate, and anatomically pre-contoured locking plate treatment of a distal humerus fracture.
Material and Method: This prospective research included patients with type 13-C2 distal humerus fractures, regardless of sex, who were hospitalized. Using the modified triceps tongue flap method, all patients received open reduction and internal fixation with anatomic pre-contoured locking plates and screws. Patients underwent 6 months of follow-up after surgery. They had follow-up evaluations using the Mayo Elbow Performance Score (MEPS) for clinical, radiological, and functional assessments. The Chi-square test was used to analyze the outcomes.
Observations: Males accounted for the majority of injuries (66.7% vs. 33.3%). The age distribution was 36.93 ± 14.67. Traffic accidents were the most common cause of injuries (66.7%). The most frequently affected side was the right upper limb (76.7%). Eighty percent of the patients had MEPS scores that were excellent or good overall. At the fracture site, the radiological union took an average of 10.2 ± 2.11 weeks. In the 6th week, the mean extension-flexion arc was 32.06°–104.06°, and in the 6th month, it was 11.55°–124.16°. Early superficial infection (3.3%), malunion (3.3%), ulnar neuropraxia (3.3%), and chronic osteomyelitis (3.3%) were the consequences. In conclusion, the functional result of the elbow was effectively preserved in distal humerus fractures treated with anatomic pre-contoured locking plates.
Keywords: Elbow joint, distal humerus intra articular fractures, bone plates, articular range of motion, osteomyelitis, MEPS, pre-contoured anatomical locking plate.

References

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20. Reising K, Hauschild O, Strohm PC, Suedkamp NP. Stabilisation of articular fractures of the distal humerus: Early experience with a novel perpendicular plate system. Injury 2009;40:611-7.
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How to Cite this article: Chitnavis S. Functional Outcome of Distal Humerus Intra-articular Fractures Treated with Pre-contoured Anatomical Locking Plates. Journal of Clinical Orthopaedics 2024 January-June;9(1):10-16.

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Is Potential Malnutrition Associated with Increased Morbidity in Total Hip and Knee Joint Arthroplasty? A Prospective Cohort Study

June 30, 2024/in For New site, Vol 9 | Issue 1 | Jan-June 2024 /by editor.jcorth

Open Access License: CC BY-NC 4.0

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.620

Author: William James Caughey [1,2], Faseeh Zaidi [1,2], Christoper Jarred Shepherd [1], Claudia Rivera-Rodriguez [3], Rocco Paolo Pitto [1,2]

[1] Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand,
[2] Department of Surgery, University of Auckland, Auckland, New Zealand,
[3] Department of Statistics, University of Auckland, Auckland, New Zealand.

Address of Correspondence
William James Caughey,
Department of Orthopaedic Surgery, Middlemore Hospital, Auckland, New Zealand.
E-mail: wjcaughey@gmail.com

Abstract

Introduction: Malnutrition is considered a risk factor for post-operative complications in total hip and knee arthroplasty, though prospective studies to investigate this assumption are lacking. The aims of this study were to prospectively analyze the 90-day post-operative complications, post-operative length of stay (LOS), and readmission rates of patients undergoing primary total hip and total knee arthroplasty using albumin, total lymphocyte count (TLC), and transferrin as serum markers of potential malnutrition.
Materials and Methods: Six hundred and three primary hip and 823 primary knee arthroplasties over a 3-year period from a single center were prospectively analyzed. Body mass index, demographic, and comorbidity data were recorded. Complications were categorized as surgical site infection (SSI), venous thromboembolism (VTE) (deep vein thrombosis and pulmonary embolus), implant-related (such as dislocation), and non-implant-related (such as pneumonia). Outcomes were compared between groups, with malnutrition, defined as serum albumin <3.5 g/dL.
Results: Potential malnutrition was present in 9.3% of the study population. This group experienced a longer average LOS at 6.5 days compared to the normal albumin group at 5.0 days (P = 0.003). SSI rate was higher in the malnourished group (12.5 vs. 7.8%, P = 0.02). There was no difference between the two groups in implant-related complications (0.8 vs. 1.0%, P = 0.95) medical complications (7.8 vs. 13.3%, P = 0.17), rate of VTE (2.3 vs. 2.7%) or 90-day readmission rate (14.1 vs. 17.0%, P = 0.56). TLC and transferrin were not predictive of any of the primary outcomes measured (P > 0.05). Pacific Island (P < 0.001), Indian (P = 0.02), and Asian (P = 0.02) patients had lower albumin than NZ European.
Conclusion: This study demonstrates an association between low albumin levels and increased post-operative LOS and SSI in total joint arthroplasty, providing support for the consideration of pre-operative nutritional screening.
Keywords: Knee arthroplasty, hip arthroplasty, malnutrition, post-operative complications, hypoalbuminemia.

References

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4. Asokan AG, Jaganathan J, Philip R, Soman RR, Sebastian ST, Pullishery F. Evaluation of bone mineral density among type 2 diabetes mellitus patients in South Karnataka. J Nat Sci Biol Med 2017;8:94-8.
5. Pittas AG, Lau J, Hu FB, Dawson-Hughes B. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab 2007;92:2017-29.
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8. Strotmeyer ES, Cauley JA, Orchard TJ, Steenkiste AR, Dorman JS. Middle-aged premenopausal women with type 1 diabetes have lower bone mineral density and calcaneal quantitative ultrasound than nondiabetic women. Diabetes Care 2006;29:306-11.
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How to Cite this article: Caughey WJ, Zaidi F, Shepherd CJ, Rivera-Rodriguez C, Pitto RP. Is Potential Malnutrition Associated with Increased Morbidity in Total Hip and Knee Joint Arthroplasty? A Prospective Cohort Study. Journal of Clinical Orthopaedics 2024 January-June;9(1):04-09.

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How to Beat Inflation with Smart Investments by Orthopods

June 30, 2024/in For New site, Vol 9 | Issue 1 | Jan-June 2024 /by editor.jcorth

Open Access License: CC BY-NC 4.0

DOI: https://doi.org/10.13107/jcorth.2024.v09i01.618

Author: Sachin Kale [1], Arvind Vatkar [2], Nrupam Mehta [3], Sonali Das [3]

[1] Department of Orthopedics, D Y Patil Hospital and Medical College, Navi Mumbai, Maharashtra, India,
[2] Department of Orthopedics, Spine Surgery Unit, Fortis Hiranandani Hospital, Navi Mumbai, Maharashtra, India.
[3] Department of Orthopaedic, Dr. D. Y. Patil Hospital, Navi Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Sachin Kale
Head of Unit, Department of Orthopedics, D Y Patil Hospital and Medical College, Navi Mumbai, Maharashtra, India.
E-mail: sachinkale@gmail.com

Editorial

Introduction
What is inflation-orthopedic perspective
In orthopedic surgery, inflation is characterized as the gradual increase in the cost of surgical materials and medical services. This drop in buying power implies that the same amount of money may buy fewer medical products and services. For example, if inflation raises the cost of essential materials and services, a conventional knee replacement operation may become more expensive. Inflation-adjusted insurance reimbursements to doctors have also fallen, implying that orthopedic surgeons may be paid less in actual terms for the same surgeries over time.

How inflation affects us
Inflation has a considerable impact on orthopedic physicians’ personal fortunes. It can reduce buying power, raise the cost of medical equipment and services, and lower the true worth of savings and investments. This can lead to greater operational expenses and less profitability for surgeons in private practice. Inflation can also impact debt payments, since many doctors with large debts may face increasing interest rates on variable-rate loans. Furthermore, if salaries and other revenues do not keep up with inflation, orthopedic surgeons’ time-adjusted income declines, limiting their capacity to save and invest for future aspirations.

**Understanding Inflation**
Understanding factors of inflation for India
Supply and demand forces combine to generate inflation in India. On the supply side, changes in agricultural output caused by irregular monsoons have a considerable impact on food costs, which account for a large portion of the Consumer Price Index (CPI). For example, unseasonal rains in late 2023 caused a jump in vegetable prices, resulting in a 7.5% CPI inflation rate in November 2023.
Furthermore, global issues such as crude oil price swings influence transportation and production costs. In 2022, the Russia-Ukraine conflict prompted crude oil prices to skyrocket, resulting in increased petrol costs in India and inflation of more than 6%.
On the demand side, increasing consumer spending and government stimulus measures, notably during the COVID-19 recovery period, have contributed to inflation. The Indian government’s numerous relief packages and direct cash transfers raised disposable income, driving up demand for goods and services.
Furthermore, structural problems, such as inefficient supply chains and excessive logistics costs, contribute to inflationary pressures. The Reserve Bank of India (RBI) strives to control inflation between 2% and 6%, but chronic supply-side constraints and unpredictable global markets make this a difficult undertaking.

How is inflation calculated
India’s inflation rate is calculated by the RBI using the CPI. The formula is: Inflation Rate = (CPI Current – CPI Previous) × 100. The current base year is 2012. The main components and their estimated weights are as follows:
• Food and beverages: 45.86%
• Housing: 10.07%.
• Clothing and footwear: 6.53%
• Fuel and light: 6.84%
• Miscellaneous (includes services, such as healthcare, education, and transportation): 28.32%.
To contain inflation and stabilize the economy, the RBI sets interest rates and monetary policy based on the CPI inflation rate.

Investment Strategies to Beat Inflation
Inflation-silent eroder of money power
Inflation has a substantial influence on the value of money since it raises prices over time, lowering the buying power of money. Assuming a 5% inflation rate, products and services that cost ₹100 this year will cost ₹105 next year. Furthermore, money held in a savings account normally generates just 4% interest, which can result in a loss of buying power if the interest rate is less than the inflation rate. In recent years, inflation rates in India have frequently exceeded 6%, resulting in a gradual loss in the capacity to purchase goods and services and a detrimental impact on long-term financial goals. Furthermore, over the years, this loss of purchasing power on your money is compounded exponentially.
Example
Let’s take an example of 1 lakh rupees invested for a 30 years horizon in banks and in equity stocks.
● Bank savings (4% interest rate):
○ Initial investment: ₹1,00,000
○ After 30 years at 4% interest:
○ Future Value = 1,00,000 × (1 + 0.04)30 = ₹3,24,339
● Equity investment (15% Return – these returns may vary on a yearly basis, but on a long-term average come to around 15%):
○ Initial investment: ₹1,00,000
○ After 30 years at 15% return:
○ Future value = 1,00,000 × (1 + 0.15)30 = ₹66,21,596
● Adjusting for 6% Inflation:
○ Real value after 30 years (using bank savings):
○ Adjusted value = 3,24,339 ÷ (1.06)30 = ₹50,438
○ Real value after 30 years (using equity):
○ Adjusted value = 66,21,596 ÷ (1.06)30 = ₹10,30,801.

Direct equity
Individual doctors setup demat accounts and buy equities based on their own research. The ideal approach is to invest in high-quality firms with honest management and consistent price growth, such as Asian Paints, Pidilite, and Reliance (please bear in mind that this is not a stock suggestion). The disadvantage is that if an investor books losses during a market downturn, they may lose a large sum of money. World events such as wars, natural catastrophes, and stock market rumors can all generate price volatility. This might produce panic and uncertainty in the minds of investors, resulting in substantial losses.

Mutual funds
Mutual funds simplify investing through integrating the investments of many people to form a diverse portfolio. Direct mutual funds are less expensive than ordinary funds, with frequently lower expense ratios. Index funds, such as the Nifty 50, offer even lower expense ratios, often ranging from 0.1% to 0.3%, and efficiently follow indexes. Most actively managed mutual funds fail to outperform the Nifty 50 index. Thus, Nifty index funds, which closely mirror index performance, frequently prove to be a better investing option for many individuals. However, mutual funds face the danger of significant losses in market collapses. Nevertheless, a long-term investment horizon of around 7–10 years yields high returns.

Real estate
Real estate is frequently seen as a good inflation hedge due to rising property values and rentals. However, real estate investments need significant resources and carry hazards such as market volatility and property upkeep fees. Real estate investments are classified into three types: Residential, commercial, and real estate investment trusts (REITs). Residential investments include homes and apartments, whereas commercial investments include office buildings, retail spaces, and industrial sites. REITs provide liquidity and diversity without owning real property, but they are susceptible to market hazards.

Commodities
Investing in gold, silver, and other commodities such as gold and silver are classic inflation hedges that hold their value during inflationary periods. Gold is chosen for its safety and liquidity, but commodities are volatile and do not provide income in the same way that dividends or rents do. Commodities normally do well during inflation as prices rise, offering a hedge against currency depreciation, but they can be impacted by global supply and demand forces.
Sovereign Gold Bonds (SGBs) are a secure and income-generating alternative to purchasing actual gold. They provide an annual interest rate of 2.5%, payable semi-annually, which increases the investment value. The interest earned is taxable, while capital gains on redemption are tax-free. SGBs have an 8-year lock-in term, with the opportunity to depart after the 5th year. Investing ₹1 lakh in SGBs over the past 8 years yields a return of around 128%, culminating in a final value of ₹2.28 lakhs, surpassing conventional gold at around 100%.

Bonds
Treasury Inflation-Protected Securities (TIPS) are government-backed investments that safeguard investors against inflation. They adjust their principal value with inflation and decrease with deflation, providing a safe, government-backed alternative with lesser yields than regular bonds. TIPS alter their principal value, offering a buffer against inflation but often with lower beginning interest rates.
In a 10-year timeframe, a ₹1 lakh investment in TIPS would increase to around ₹1,81,940, whereas the same money in a bank FD at 6% interest would rise to roughly ₹1,79,085. TIPS generate a somewhat higher return, due to the inflation protection component, which enhances total yields.

Practical Guidelines for Investors
1. An actionable approach for doctor investors would be to invest in mutual funds using platforms such as Kuvera and Coin, which provide direct investing in mutual funds. This helps to lower the expenditure ratio
2. Invest around 10–20% of your monthly income on a monthly basis (Systematic investment plans) rather than just accumulating in your bank
3. Prefer index mutual funds, such as the Nifty index funds
4. Make recurring investing in high-quality stocks with a strong reputation. This research must be conducted by the investor himself or through portfolio management services
5. Continue to purchase SGBs rather than physical gold wherever feasible
6. Commercial real estate should be preferred over residential real estate since it generates higher rents and appreciates more quickly
7. Do not keep a lot of cash, as it erodes its value. Instead, try to invest in real estate
8. Pay taxes regularly and try to use all the sections of tax deductions with the help of a good chartered accountant.
(These guidelines are suggestions and recommendations and authors are not liable for any losses incurred by following these tips)

Conclusion
In India, orthopedic doctors may fight inflation by properly distributing assets across asset classes. These include equities, mutual funds, stocks, and debt instruments, such as SGBs, real estate, and REITs, as well as inflation-indexed bonds. By combining these assets with a balanced portfolio, doctors may establish a solid financial foundation while navigating inflationary challenges, assuring their financial future.

How to Cite this article: Kale S, Vatkar A, Mehta N, Das S. How to Beat Inflation with Smart Investments by Orthopods. Journal of Clinical Orthopaedics 2024;January-June:9(1):01-03.

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Current Strategy of Management of Distal Radius Fractures in Geriatric Populations

December 28, 2023/in For New site, Vol 8 | Issue 2 | July - Dec 2023 /by editor.jcorth

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

Authors: Parag B Lad [1, 2]

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

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

Abstract

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

References

1. Fader L, Blackburn E. What is the evidence in treating distal radius fractures in the geriatric population? Hand Clin 2021;37:229-37.
2. Nellans KW, Kowalski E, Chung KC. The epidemiology of distal radius fractures. Hand Clin 2012;28:113-25.
3. Lafontaine M, Hardy D, Delince P. Stability assessment of distal radius fractures. Injury 1989;20:208-10.
4. Mauck BM, Swigler CW. Evidence-based review of distal radius fractures. Orthop Clin North Am 2018;49:211-22.
5. Young BT, Rayan GM. Outcome following nonoperative treatment of displaced distal radius fractures in low-demand patients older than 60 years. J Hand Surg Am 2000;25:19-28.
6. Anzarut A, Johnson JA, Rowe BH, Lambert RG, Blitz S, Majumdar SR. Radiologic and patient-reported functional outcomes in an elderly cohort with conservatively treated distal radius fractures. J Hand Surg Am 2004;29:1121-7.
7. Jaremko JL, Lambert RG, Rowe BH, Johnson JA, Majumdar SR. Do radiographic indices of distal radius fracture reduction predict outcomes in older adults receiving conservative treatment? Clin Radiol 2007;62:65-72.
8. Arora R, Gabl M, Erhart S, Schmidle G, Dallapozza C, Lutz M. Aspects of current management of distal radius fractures in the elderly individuals. Geriatr Orthop Surg Rehabil 2011;2:187-94.
9. Chung KC, Shauver MJ, Yin H, Kim HM, Baser O, Birkmeyer JD. Variations in the use of internal fixation for distal radial fracture in the United States medicare population. J Bone Joint Surg Am 2011;93:2154-62.
10. Walsh A, Merchan N, Bernstein DN, Ingalls B, Harper CM, Rozental TD. Predictors of management of distal radius fractures in patients aged >65 years. Hand (N Y) 2022;17:25S-30.
11. Tulipan JE, Lechtig A, Rozental TD, Harper CM. “Age is just a number”: Distal radius fractures in patients over 75. Hand (N Y) 2022;17:128-33.
12. Cooper AM, Wood TR, Scholten Ii DJ, Carroll EA. Nonsurgical management of distal radius fractures in the elderly: Approaches, risks and limitations. Orthop Res Rev 2022;14:287-92.
13. Kim KH, Duell B, Munnangi S, Long M, Morrison E. Radiographic predictors of delayed carpal tunnel syndrome after distal radius fracture in the elderly. Hand (N Y) 2022;17:652-8.
14. Gutiérrez-Espinoza H, Araya-Quintanilla F, Olguín-Huerta C, Gutiérrez-Monclus R, Valenzuela-Fuenzalida J, Román-Veas J, et al. Effectiveness of surgical versus conservative treatment of distal radius fractures in elderly patients: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2022;108:103323.
15. Olech J, Kopczyński B, Tomczyk Ł, Konieczny G, Kazubski K, Morasiewicz P. The functional and radiographic outcomes following distal radius fracture treatment in a cast for 4 and 6 weeks in the elderly: A randomized trial. Adv Clin Exp Med 2022;31:701-6.

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

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

December 28, 2023/in For New site, Vol 8 | Issue 2 | July - Dec 2023 /by editor.jcorth

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

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

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

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

Abstract

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

References

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

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

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

December 28, 2023/in For New site, Vol 8 | Issue 2 | July - Dec 2023 /by editor.jcorth

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

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

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

Address of Correspondence

Dr. Gaurav Garg,

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

E-mail: gauravgarg9999@gmail.com

Abstract

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

References

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

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

December 28, 2023/in For New site, Vol 8 | Issue 2 | July - Dec 2023 /by editor.jcorth

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

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

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

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

Abstract

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

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

References

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

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

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