A Malunited Fibula with raised Lateral Malleolus treated Surgically by Fibular Osteotomy and Plating

Vol 3 | Issue 2 |  July-Dec 2018 | Page 54-55 | HR Jhunjhunwala.

Authors: HR Jhunjhunwala [1].

[1] Department of Orthopaedics, Bombay Hospital Postgraduate Institute of Medical Sciences, Marine Lines, Mumbai, India.

Address of Correspondence
Dr. HR Jhunjhunwala,
Department of Orthopaedics, Bombay Hospital Postgraduate Institute of Medical Sciences, Marine Lines, Mumbai, India.
Email: drhrj2@gmail.com


Isolated fibular fractures are often considered innocuous and treated conservatively. They may malunited and predispose the ankle to severe twisting injuries. We present one such case where the patient presented with twisting injury to the ankle. Radiograph revealed a malunited fibula which was high riding. To prevent future such episodes, fibula was pulled down by doing an osteotomy and was stabilised with a plate. The union was uneventful and at final follow up pf two years the patient is symptom free
Keywords: malunited fibula, Osteotomy


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How to Cite this article: Jhunjhunwala HR. A Malunited Fibula with raised Lateral Malleolus treated surgically by Fibular Osteotomy and Plating. Journal of Clinical Orthopaedics July-Dec 2018; 3(2):54-55.

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Reconstruction of Ankle Mortise following Resection of Giant Cell Tumor of Distal Fibula

Vol 3 | Issue 2 |  July-Dec 2018 | Page 51-53 | Dinesh Chidambaram, Prakash Sengottaiyan, Karthikeyan Chinnaswami.

Authors: Dinesh Chidambaram [1], Prakash Sengottaiyan [2], Karthikeyan Chinnaswami [1].

[1] Dept of Orthopaedic Surgery, Royal Care Superspeciality Hospital, Neelambur, Coimbatore, Tamilnadu, India
[2] Dept of Plastic Surgery, Royal Care Superspeciality Hospital, Coimbatore, India

Address of Correspondence
Dr. Dinesh Chidambaram,
Royal Care Superspeciality Hospital, Neelambur, Coimbatore, Tamilnadu, India
Email: dineshchidambaram75@gmail.com


Introduction: Giant cell tumor commonly occurs in the age group of 20-40 years with the commonest predilection around the knee joint. This case is presented here for its rare occurence in the distal fibula and its unique management.
Case report: 25 year old male patient presented with complaints of pain and swelling over the outer aspect of left ankle for one year. On examination there was a diffuse swelling over distal third fibula with classical egg shell cracking consistency. Imaging with X ray, Computed tomography (CT) and Magnetic resonance imaging (MRI) revealed eccentric, expansile, lytic lesion with cortical breech. Thus a preoperative diagnosis of Giant Cell tumor(GCT) was made. Chest X ray and CT Chest were normal. Trucut Biopsy revealed features suggestive of Giant Cell Tumor. Locally aggressive tumor in an expendable bone warrants resection of distal fibula to prevent recurrence, which compromises ankle stability. So we did wide resection of the distal fibula and reconstruction of the ankle mortise with ipsilateral proximal fibula. Biceps femoris tendon and fibular collateral ligament were secured with suture anchor to lateral proximal tibia to avoid knee instability. Excision biopsy revealed giant cell tumor with margins free of tumor invasion. At one year follow up, there is no recurrence locally and patient walks without any support with normal knee and ankle range of movements . There is no lateral opening of knee joint on varus stress test with knee in 30 degree flexion. Mean musculoskeletal tumor society (MSTS) score was 100%.
Conclusion: Giant cell tumor involving distal fibula is very rare. Owing to high recurrence rate, resection of tumour in toto and to enable the patient with good ankle stability, reconstruction of ankle mortise with ipsilateral proximal fibula is an appropriate mode of management especially in young patients.
Keywords: GCT, Distal Fibula, Resection and Reconstruction with Proximal Fibula


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How to Cite this article: Dinesh C, Sengottaiyan P, Chinnaswami K. Reconstruction of ankle mortise following resection of giant cell tumor of distal fibula. Journal of Clinical Orthopaedics July-Dec 2018; 3(2):51-53.

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Three Stitch technique for Humerus Nailing

Vol 3 | Issue 2 |  July-Dec 2018 | Page 48-50 | Sachin Kale, Vaibhav Koli, Prakash Samant, Sanjay Dhar, Sandeep Deore, Gaurav Kanade.

Authors: Sachin Kale [1], Vaibhav Koli [1], Prakash Samant [1], Sanjay Dhar [1], Sandeep Deore [1], Gaurav Kanade [1].

[1] Department of Orthopaedic surgery, Dr. D.Y. Patil medical college, Nerul,Navi Mumbai.

Address of Correspondence
Dr. Vaibhav Koli,
Department of Orthopaedics, Dr. D.Y. Patil medical college, Nerul,Navi Mumbai.
E-mail id: vaibhavkoli08@gmail.com


Intramedullary nailing for humerus diaphyseal fractures is associated with a quite a number of complications like violation of rotator cuff, soft tissue injury around the shoulder and elbow. The purpose of this article is to describe a simple three stitch technique for intramedullary humerus nailing which aims at avoiding most of the common complications encountered during and after humerus nailing. One year follow up of all the patients have shown good to excellent results and favorable functional outcomes.
Keywords: humerus diaphyseal fractures, antegrade humerus nailing, three stitch technique


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6. Cheng HR, Lin J. Prospective randomized comparative study of antegrade and retrograde locked nailing for middle humeral shaft fracture. J Trauma. 2008;65:94-102.
7. Sarmiento A, Kinman P, Galvin E. Functional bracing of fractures of the shaft of the humerus. JBJS (Am) 1977; 59- A.596-601
8. RG McCormack, D. Brien, RE Buckley, MD McKee, J Powell, EH Schemitsch. Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail. A prospective randomised trial. JBJS (Br) 2000; 82-B: 336-9
9. Christos Garnavos.Diaphyseal humeral fractures and intramedullary nailing: Can we improve outcomes. Indian Journal of Orthopaedics | May 2011 | Vol. 45 | Issue 3,Pg 208-213
10. Stern PJ, Mattingly DA, Pomeroy DL, Zenni EJ Jr, Kreig JK. Intramedullary fixation of humeral shaft fractures. J Bone Joint Surg Am 1984;66:639-46.
11. Evans PD, Conboy VB, Evans EJ. The Seidel humeral lockingnail: an anatomical study of the complications from locking screws. Injury 1993;24:175-6.
12. Garnavos C. Intramedullary nailing for humeral shaft fractures: the misunderstood poor relative. Current Orthop 2001; 15:68-75.
13. Kolonja A, Vecsei N, Mousani M, Marlovits S, Machold W, Vecsei V. Radial nerve injury after anterograde and retrograde locked intramedullary nailing of humerus. A clinical and anatomical study. Osteo Trauma Care 2002;10:192-6.

How to Cite this article: Kale S, Koli V, Samant P, Dhar S, Deore S, Kanade G. Three Stitch technique for humerus nailing. Journal of Clinical Orthopaedics July-Dec 2018; 3(2):48-50.

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Surgical treatment of Posterior Malleolus Fracture

Vol 3 | Issue 2 |  July-Dec 2018 | Page 44-47 | Nicholas Antao, K.S. Kushalappa, Rajesh Hingwe, Ashish Upadhyay.

Authors: Nicholas Antao [1], K.S. Kushalappa [1], Rajesh Hingwe [1], Ashish Upadhyay [1].

[1] Department of Orthopaedic surgery, Holy Spirit Hospital, Mumbai, Maharashtra

Address of Correspondence
Dr. Nicholas Antao,
Dept. of Orthopaedics, Holy Spirit Hospital, Mahakali Road, Andheri (E), Mumbai – 400093 India.
Email: narantao@gmail.com


Introduction: Posterior malleolus fractures mostly occur in association with fractures of other malleoli. The current recommendation is fixation based on the size of the fragment.
Materials & Methods: A retrospective study of 30 cases of posterior malleolus was conducted. There were 4 cases in type 1, 8 cases in Type 2, 7 cases in type 3, 10 cases in Type 4 and Type 5 there was one case. Type 1 were not operated, and type 5 were left alone in POP cast for 6 weeks. Type 2, 3 and 4 were operated either by cannulated cancellous screw by trans-Achilles approach, when the fragment was less than 20% of the surface area in 6 cases. When the surface exceeded 15% , those cases were treated with osteosynthesis by posterolateral approach using a buttress plate principle.
Results: Good results were seen in all cases except one which develop post-operative infection and had early arthritis.
Conclusion: Radiological studies are essential to plan, and posterolateral approach provides a good exposure for management of posterior malleolar fractures
Keywords: Posterior malleolar fracture, fixation, 3D CT scan


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How to Cite this article: Antao N, Kushalappa KS, Hingwe R, Upadhyay A. Surgical treatment of posterior malleolus fracture. Journal of Clinical Orthopaedics July -Dec 2018; 3(2):44-47.

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Prevalence of Nerve Injuries in Lower Limb following Total Joint Replacement Surgery, and Management

Vol 3 | Issue 2 |  July-Dec 2018 | Page 36-43 | Kunal Ajitkumar Shah, Mohan M Desai.

Authors: Kunal Ajitkumar Shah [1], Mohan M Desai [1].

[1] Department of Orthopaedics, KEM Hospital, Parel Mumbai

Address of Correspondence
Dr. Mohan Desai,
Department of Orthopaedics, KEM Hospital, Parel Mumbai
Email: md1964@gmail.com


Nerve injuries during lower limb joint replacement are uncommon but serious complications. Review of this condition is sparse in literature. The present review aims to collate the current literature and provide an overview of the subject. Subclinical cases are quite common and preoperative counseling would be helpful. In case the nerve injury occurs, assurance and counselling helps. Since, the prognosis is not uniform and depends on multiple factors, it is best to try and avoid these iatrogenic injuries. A good surgeon knows how to manage his complications, but the best surgeon knows how to avoid them!
Keywords: Nerve injuries, knee arthroplasty, hip arthroplasty, iatrogenic


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How to Cite this article: Shah K, Desai M. Prevalence of Nerve Injuries in Lower Limb following Total Joint Replacement Surgery, and Management. Journal of Clinical Orthopaedics July-Dec 2018; 3(2):36-43.

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Vol 3 | Issue 2 |  July-Dec 2018 | Page 30-35 | Ramesh K Sen, Manuj Aggarwal.

Authors: Ramesh K Sen [1], Manuj Aggarwal [1].

[1] Institute of orthopaedics, Max hospital Mohali, India

Address of Correspondence
Dr. Ramesh Sen,
Institute of orthopaedics, Max hospital Mohali, India
Email: senramesh@rediffmail.com


Orthobiologics is a newer science that has biologic-based therapies for treatment of various hip, knee, ankle and shoulder pathologies. It involve biological sources which promote and accelerate bone and soft tissue healing and based on theoretical advantages in focal chondral defect, osteoarthritis, AVN hip, plantar fasciitis and various tendinopathies. Strong evidence which support the use of biologic agent such as hyaluronic acid, platelet rich plasma bone marrow aspirate concentrate, largely remain absent from the literature. This article review the existing literature on most commonly employed biologic agent for the different knee, hip, and ankle pathologies. There was a lack of clinical evidence for various treatment strategies; therefore we suggest that there is a need for comparative studies in future.
Keywords: Orthobiologics, Hyaluronic acid, platelet rich plasma, Bone marrow aspirate concentrate; Adipose derived stem cells, Osteoarthritis


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How to Cite this article: Sen RK, Aggarwal M. Orthobiologics-Today. Journal of Clinical Orthopaedics Jan-June 2018; 3(2):30-35.

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Simultaneous Bilateral Total Knee Replacement – Current Evidence Based Management Strategy

Vol 3 | Issue 2 |  July-Dec 2018 | Page 22-29 | Abhishek Patil, Nandan Rao.

Authors: Abhishek Patil [1], Nandan Rao [2].

[1] Department of Joint Replacement and Orthopaedics, Sahyadri Superspeciality Hospital Hadapsar, Pune, Maharashtra, India
[2] Department of Orthopaedics Reliance Hospital, Navi Mumbai, Maharashtra, India.

Address of Correspondence
Dr. Abhishek Patil, Sahyadri Superspeciality Hospital, Survey number 163, Bhosale nagar, Pune-Solapur road, Hadapsar, Pune. 411028
Email- abhipatortho@gmail.com


With an ever-increasing geriatric population and associated knee arthritis; the number of patients requiring total knee arthroplasty continues to rise. In India 94% of patients with Kellegren-Lawrence grade 3 or 4 arthritis have bilateral arthritis. As such bilateral knee arthroplasty offers the convenience of single surgery, concomitant recovery and rehab of both knees and significant cost savings. However traditionally simultaneous bilateral knee replacement has been associated with higher mortality- both in hospital and after discharge extending up to 1 year and higher morbidity due to cardio-pulmonary complications, deep vein thrombosis, pulmonary embolism and higher rates of readmissions. With modern day surgical refinements and improved anesthetic practices; recent studies have reported results and complications at par with unilateral and staged bilateral total knee arthroplasty. However controversies do remain over the applicability of doing simultaneous bilateral knee arthroplasty. Ethical considerations and rarity of complications have made it difficult to conduct adequately powered randomized trials to justify or refute the practice of simultaneous bilateral knee arthroplasty. This review tries to amalgamate the views of recent literature to give the present status and best practices in simultaneous bilateral total knee arthroplasty.
Keywords: Total knee arthroplasty, bilateral total knee arthroplasty, bilateral knee replacement, knee arthritis, knee arthroplasty, knee replacement.


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How to Cite this article: Patil A, Rao N. Simultaneous Bilateral Total Knee Replacement – Current Evidence Based Management Strategy. Journal of Clinical Orthopaedics July-Dec 2018; 3(2):22-29.

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Pediatric ACL in Sports, Prognosis, Decision Making and Outcomes of Management

Vol 3 | Issue 2 |  July-Dec 2018 | Page 16-21 | Reha N. Tandoğan, Metin Polat.

Authors: Reha N. Tandoğan[1], Metin Polat [2].

[1] ankaya Orthopedics, Ankara, Turkey,
[2] Orthopedic Surgeon, Cankaya Orthopedics, Ankara, Turkey

Address of Correspondence
Dr. Reha N. Tandogan,
Cinnahcaddesi 51/4 Cankaya Ankara, Turkey
Email: rtandogan@ortoklinik.com


Anterior cruciate ligament (ACL) injuries in pediatric & adolescent patients may occur as tibial eminence fractures, mid-substance ligament injuries and peel-off injuries of the femoral insertion site. ACL injuries in adolescents nearing skeletal maturity may be treated as adults without risk of deformity or leg length discrepancy. Treatment of ACL injuries children with wide open physes and substantial remaining growth are controversial. Disappointing functional results and an increased prevalence of secondary meniscal and cartilage damage with conservative management have led to an increased utilization of surgical treatment in these children. ACL reconstruction with soft tissue grafts and physeal sparing techniques are considered the gold standard of surgical management. Primary repair combined with healing enhancement techniques for femoral peel-off injuries with minimal damage to the body of the ACL can be used in select cases. The rates of growth disturbance after ACL surgery remain low with modern techniques and are usually clinically insignificant. However, a higher rate of failure and need for revision has been reported in pediatric & adolescent ACL injuries compared to adults. The risk of failure increases in patients with allografts and who return to high risk impact sports.
Keywords: Paediatric ACL tEAR, Physeal sparing techniques, repair


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How to Cite this article: Tandoğan R N, Polat M. Pediatric ACL in sports, prognosis, decision making and outcomes of management. Journal of Clinical Orthopaedics July-Dec 2018;3(2):16-21.

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History and Future Direction of Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears

Vol 3 | Issue 2 |  July-Dec 2018 | Page 12-15 | Teruhisa Mihata.

Authors: Teruhisa Mihata [1,2,3].

[1] Department of Orthopedic Surgery, Osaka Medical College, Takatsuki, Osaka, Japan
[2] Orthopaedic Biomechanics Laboratory, Congress Medical Foundation, Pasadena, California, USA
[3] Katsuragi Hospital, Kishiwada, Osaka, Japan

Address of Correspondence
Dr. TeruhisaMihata,
Department of Orthopedic Surgery, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
Email: tmihata@yahoo.co.jp, tmihata@osaka-med.ac.jp


Lesions of the superior shoulder capsule had been a neglected entity before I reported my technique for superior capsule reconstruction (SCR).I had noticed that patients with irreparable rotator cuff tears always had irreparable defects of the superior shoulder capsule as well as the rotator cuff tendons, because the superior shoulder capsule is attached to the undersurface of these tendons. Therefore, I hypothesized that reconstruction of the superior shoulder capsule might be useful to prevent superior migration of the humeral head and subacromial impingement in irreparable rotator cuff tears. To prove my hypothesis, our group performed a cadaveric biomechanical study in 2005. This biomechanical study showed that SCR completely restored superior stability of the glenohumeral joint, whereas patch grafting to the supraspinatus tendon (conventional patch graft surgery) only partially restored superior translation to the intact level. Consequently, in 2007,we started arthroscopic SCR for patients with irreparable rotator cuff tears. From our 10 years of experience with SCR, we conclude that arthroscopic SCR restores superior glenohumeral stability and improves shoulder function in irreparable rotator cuff tears.
Keywords: Irreparable, Reconstruction, Rotator Cuff, Shoulder, Superior capsule


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How to Cite this article: Mihata T. History and Future Direction of Superior Capsule Reconstruction for Irreparable Rotator Cuff Tears. Journal of Clinical Orthopaedics July-Dec 2018; 3(2):12-15.

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Support Journal of Clinical Orthopaedics

Vol 3 | Issue 2 |  July-Dec 2018 | Page 1 | Nicholas Antao, Ashok Shyam.

Authors: Nicholas Antao [1], Ashok Shyam [2,3].

[1] Hill Way Clinic, Hill N Dale Building, 4th Floor, Hill Road, Bandra West, Mumbai – 400050
[2] Sancheti Institute for Orthopaedics and Rehablitation, Pune, India
[3] Indian Orthopaedic Research Group, Thane, India.

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

Dear Colleagues, as you know the BOS Journal is now completing its third year of successful publication and is looking strong and steady. Steady and regular publication is a sign of good journal and with the help of editorial team we were able to do a good job. The Journal is indexed as per MCI criteria; however, it is time now to take the Journal of Clinical Orthopaedics to next Level and improve the indexing status too.

The first step in doing so will be to increase the submission of original articles and case reports to the journal. We are currently soliciting review articles from BOS members and from across the globe, however in order improve the indexing we will need more original articles and case reports for the journal. In the current issue we have 25% articles as original articles, however this must go up to 50%. Secondly, we have to improve our peer review system and we would request all BOS members to support the journal by participating in the peer review process. Becoming a reviewer for the journal is very simple and a direct link is provided on the website. Once you become a reviewer, articles will be regularly sent to you for peer review. This will help in getting good reviews for the journal and also help potential authors familiarise with the journal processes. Lastly, we would request our members to spread the word about the journal and to help us solicit more article for our journal.

We are also starting a new section in the Journal named ‘BOS Reflections’ that will provide overview on various BOS activities. We will cover details of long running courses of BOS as well as Master series. This will put forth to the readers, how the BOS courses have grown to achieve the iconic status across the country & beyond. In this issue we are focussing on the BOS Computer Skills course which was co-Founded by Taral Nagda and Neeraj Bijlani. This was one of its kind course in the country when it started and still continues to be one of its kind with huge attendance over the years. Dr Neeraj Bijlani will take you through very interesting Journey of this course and we hope many would be excited to read this section. We also have our Past president Dr CJ Thakkar sharing his experiences on becoming a licensed pilot in USA. The regular feature of Walkathon features Dr GS Kulkarni this year and many more features make this WIROC issue unique.

We express our thanks to all the authors and reviewers who contributed to this years issues and request for continued support in coming years. Journal of Clinical Orthopaedics has a good start and we need to follow up upon it and help it become a great journal in orthopaedics. With help of BOS members, this is absolutely achievable. We leave you on this positive note, please send your feedback to editor.jcorth@gmail.com

Warm Regards
Dr Nicholas Antao (Editor- JCOrth)
Dr Ashok Shyam (Associate Editor- JCOrth)

How to Cite this article: Antao N, Shyam AK. Support the Journal of Clinical Orthopaedics. Journal of Clinical Orthopaedics July -Dec 2018; 3(2):1.

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