Current trends in ACL repair: Primary repair, mechanical augmentation and biological supplementation

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page:36-40 | Rajeev Raman, Bibhuti Nath Mishra


Author: Rajeev Raman [1], Bibhuti Nath Mishra [2]

[1] Consultant Orthopaedic Surgeon, Joint & Bone Care Hospital, Salt Lake City, Kolkata, India
[2] Consultatnt Orthopaedic Surgeon, Birat Medical College Teaching Hospital, Biratnagar, Nepal.

Address of Correspondence
Dr. Bibhuti Nath Mishra,
Birat Medical College Teaching Hospital, Biratnagar, Nepal
E-mail: drbibhuti5@gmail.com


Abstract

Anterior Cruciate Ligament (ACL) tear is one amongst frequent knee injuries. This injury is troublesome as it causes instability of knee while walking/running and also predisposes to the risk of early osteoarthritis in long run. So, its proper management is important, but has always remained debatable and controversial as well. Advancements in tissue engineering and regenerative medicine has changed the understanding of ACL’s anatomy and it’s healing potential and thus a renewed interest has emerged towards ACL repair again over the established gold standard “ACL reconstruction”. Novel techniques like bridging with fiber tapes, Internal Brace Ligament Augmentation (IBLA), and Dynamic Intraligamentary Stabilization (DIS) have emerged focusing on mechanical strength. Also, supplements like bio-scaffolds, platelets & platelet rich plasma (PRP) are in the offing to aid biological ligamentous healing. We will present review of past practice, current trend and future prospects of ACL repair.
Keywords: Anterior Cruciate Ligament; Repair; Reconstruction; Augmentation; Supplementation


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How to Cite this article: Raman R, Mishra BN. Current trends in ACL repair: Primary repair, mechanical augmentation and biological supplementation. Journal of Clinical Orthopaedics July-Dec 2020;5(2):36-40.

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Orthopaedic and trauma management in covid-19 era: common problems and their probable solution in literature, a narrative review

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page:13-19 | Siddharth Dubey, Sidharath Mohindru, Md. Quamar Azam, Bhaskar Sarkar


Author: Siddharth Dubey [1], Sidharath Mohindru [1], Md. Quamar Azam [1], Bhaskar Sarkar [1]

[1] Department of Trauma Surgery AIIMS Rishikesh

Address of Correspondence
Dr. Sidharath Mohindru,
Department of Trauma Surgery AIIMS Rishikesh
E-mail: sidharathmohindru10@gmail.com


Abstract

Purpose: COVID-19 has affected more than 200 countries and has warranted change in the hospital policies and patient management worldwide. It has brought forward many challenges which were and still are being faced by the health care setup in various nations. There still are many unanswered questions and doubts arising in the minds of orthopaedic trauma surgeons all over regarding this pandemic. This article is an attempt to summarise the current knowledge about COVID-19 in relation to orthopaedic trauma.
Methods: This is a review article presenting concise, collected ideas from exhaustive literature taken from PubMed, Google Scholar and Cochrane reviews. Key words such as “COVID-19”, “Management”, “Orthopaedics” and “Trauma” were used and information from various articles has been presented in a concise manner, including the authors’ own personal experience.
Results: There has been a reduction in major trauma cases presenting to the emergency and a dramatic reduction in trauma admissions during the COVID-19 pandemic. Orthopaedic surgeons need to work alongside other frontline health care workers to tackle this calamity. Hospital resources need to be appropriately used in order to provide optimal patient care alongside minimising the risk of spread of infection to other patients and hospital personnel. The decision to operate needs to be a fine balance between suspected orthopaedics and trauma related complications and worsening of respiratory function in patients who are COVID-19 positive.
Conclusion: As orthopaedic surgeons, it is our moral responsibility to try to reduce the impact of the pandemic in which ever manner possible. There is still a lot to discover and guidelines are constantly changing, so it is also important that surgeons stay up to date on the latest protocols.
Key words: COVID-19. Management. Orthopaedic. Trauma.


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How to Cite this article: Dubey S, Mohindru S, Azam Md. Q, Sarkar B. Orthopaedic and trauma management in covid-19 era: common problems and their probable solution in literature, a narrative review. Journal of Clinical Orthopaedics July-Dec 2020;5(2):13-19.

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Potential Combination of Hesperetin and Vitamin C based on PLGA (Poly Lactic-co-Glycolic Acid) on Healing Fragility Fracture in Osteoporosis Patients

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page: 25-29 | Kadek Mercu Narapati Pamungkas, Putu Itta Sandi Lesmana Dewi, Made Agus Maharjana


Author: Kadek Mercu Narapati Pamungkas [1], Putu Itta Sandi Lesmana Dewi [1], Made Agus Maharjana [2]

[1] Bachelor of Medicine and Medical Doctor Profession Study Program of Udayana University, Indonesia
[2] Department of Orthopedics and Traumatology, Faculty of Medicine, Udayana University- Sanglah General Hospital, Indonesia

Address of Correspondence
Dr. Kadek Mercu Narapati Pamungkas,
Bachelor of Medicine and Medical Doctor Profession Study Program of Udayana University, Indonesia
E-mail: narapatipamungkas@student.unud.ac.id


Abstract

Background: Osteoporosis is a degenerative bone disease that occurs around 15.3% in Southeast Asia. Osteoporosis patients are very vulnerable and often experience fragility fractures. Until now, the treatment of fragility fractures, namely pharmacological and operative therapy, has not been optimal in restoring bone density and allowing recurrence.
Purpose: The aim of this research is to find the modality of therapy fragility fracture that can prevent and improve the condition. Methods: This literature was prepared using literature review methods being sourced from valid medical journals such as published in PubMed, Research Gate, and Google Scholar.
Results: Hesperetin in citrus fruit can inhibit RANKL-induced osteoclastogenesis, reduce the amount and size of F-actin, and accelerate fracture healing in vivo. Vitamin C, which is also present in citrus fruit, has an important role in the synthesis of the triple helix collagen and shows better fracture healing at week 4. PLGA has a role in more specific drug delivery, preventing rapid clearance, biodegradable, increasing calcium deposition, and extending drug release time.
Conclusion: Combination of Hesperetin and PLGA-based vitamin C can be promising therapies in the healing and prevention of fragility fractures. Suggestion: The author suggests conducting further research to determine side effects, proper dosage, and drug administration.
Keywords: Fragility Fracture, Hesperetin, PLGA, Vitamin C


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How to Cite this article: Pamungkas KMN, Dewi PISL, Maharjana MA. Potential Combination of Hesperetin and Vitamin C based on PLGA (Poly Lactic-co-Glycolic Acid) on Healing Fragility Fracture in Osteoporosis Patients. Journal of Clinical Orthopaedics July-Dec 2020;5(2):25-29.

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Challenges and Difficulties faced by Orthopedic Surgeons during the COVID-19 Pandemic: A Review of Modified Surgical Protocols

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page: 20-24 | Sajeev Shekhar, Vivek Shetty, Yash Wagh


Author: Sajeev Shekhar [1], Vivek Shetty [1], Yash Wagh [1]

[1] Department of Orthopedics, P.D. Hinduja National Hospital & MRC, Veer Savarkar Marg, Mahim West, Mumbai – 400016

Address of Correspondence
Dr. Vivek Shetty,
Department of Orthopedics, P.D. Hinduja National Hospital & MRC, Veer Savarkar Marg, Mahim West, Mumbai – 400016
E-mail: vivshetty7777@gmail.com


Abstract

Introduction: Since the major outbreak of COVID-19 in March 2020, all hospitals and surgeons opted to postpone elective scheduled surgeries for personal and patient safety
Aim of this study: In this study of 45 consecutive patients, we changed the surgical protocols during this pandemic, our study highlights difficulties faced and how they were tackled.
Materials and Methods: 45 patients were included in this study operated by a single Senior Surgeon at a tertiary centre and their results were compared to similar surgeries performed in the pre-Covid era, in terms of length of hospital stay, duration of surgery, complications/mortality post operatively and overall risk of infection to the patients and hospital staff.
Results: It was found that the, mortality and morbidity in both times were same in Covid-19 negative patients, overall time taken for the surgery was increased, the hospital stay was increased, usage of resources was increased, difficulties faced were not only by the patients but also the health workers.
Keywords: COVID-19, protocols, donning in, doffing off, operation time, aerosol,.


References

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2. Iyengar KP, Jain VK, Vaish A, Vaishya R, Maini L, Lal H. Post COVID-19: Planning strategies to resume orthopaedic surgery –challenges and considerations. J Clin Orthop Trauma. 2020;11:S291-S295. doi:10.1016/j.jcot.2020.04.028
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11. Rodrigues-Pinto R, Sousa R, Oliveira A. Preparing to Perform Trauma and Orthopaedic Surgery on Patients with COVID-19. J Bone Joint Surg Am. 2020;102(11):946-950. doi:10.2106/JBJS.20.00454
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How to Cite this article: Shekhar S, Shetty V, Wagh Y. Challenges and Difficulties faced by Orthopedic Surgeons during the COVID-19 Pandemic: A Review of Modified Surgical Protocols. Journal of Clinical Orthopaedics July-Dec 2020;5(2):20-24.

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Meniscus Root Injury: A review

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page:41-44 | Rajkumar S Amaravathi


Author: Rajkumar S Amaravathi [1]

[1] Department of Arthroscopy and Sports Injury,St John’s Medical College, Bangalore 560034, Karnataka

Address of Correspondence
Dr. Rajkumar S Amaravathi,
Professor Orthopedics,
Head Division of Arthroscopy and Sports Injury,St John’s Medical College, Bangalore 560034, Karnataka
E-mail: rajamarvathi@gmail.com


Abstract

The meniscus provides shock absorption and stability by generating circumferential stresses as load bearing occurs. This is because of the root attachments of the meniscus to the tibia, preventing meniscus extrusion and a subsequent alteration of the transmitted hoop .Meniscus root tears lead to an increase of peak tibiofemoral contact pressure and tibiofemoral contact area which has been shown to lead to altered biomechanics and an acceleration of degenerative changes of the knee. The treatment method for meniscus injuries now primarily is preservation and anatomic restoration, because non-operative and meniscectomy treatments are associated with poor clinical outcomes and progression to degenerative changes in the joint.
Keywords: Meniscus Root Injury.


References

1. Hwang BY, Kim SJ, Lee SW, Lee HE, Lee CK, Hunter DJ, Jung KA. Risk factors for medial meniscus posterior root tear. Am J Sports Med. 2012 Jul;40(7):1606-10. doi: 10.1177/0363546512447792. Pub 2012 May 11. PMID: 22582224.
2. De Smet AA, Blankenbaker DG, Kijowski R, Graf BK, Shinki K. MR diagnosis of posterior root tears of the lateral meniscus using arthroscopy as the reference standard. AJR Am J Roentgenol. 2009 Feb;192(2):480-6. doi: 10.2214/AJR.08.1300. PMID: 19155414.
3. Pache S, Aman ZS, Kennedy M, Nakama GY, Moatshe G, Ziegler C, LaPrade RF. Meniscal Root Tears: Current Concepts Review. Arch Bone Jt Surg. 2018 Jul;6(4):250-259. PMID: 30175171; PMCID: PMC6110430.
4. Allaire R, Muriuki M, Gilbertson L, Harner CD. Biomechanical consequences of a tear of the posterior root of the medial meniscus. Similar to total meniscectomy. J Bone Joint Surg Am. 2008 Sep;90(9):1922-31. doi: 10.2106/JBJS.G.00748. PMID: 18762653.
5. Frank JM, Moatshe G, Brady AW, Dornan GJ, Coggins A, Muckenhirn KJ, Slette EL, Mikula JD, LaPrade RF. Lateral Meniscus Posterior Root and Meniscofemoral Ligaments as Stabilizing Structures in the ACL-Deficient Knee: A Biomechanical Study. Orthop J Sports Med. 2017 Jun 15;5(6):2325967117695756. doi: 10.1177/2325967117695756. PMID: 28660229; PMCID: PMC5476330.
6. LaPrade CM, Foad A, Smith SD, Turnbull TL, Dornan GJ, Engebretsen L, Wijdicks CA, LaPrade RF. Biomechanical consequences of a nonanatomic posterior medial meniscal root repair. Am J Sports Med. 2015 Apr;43(4):912-20. doi: 10.1177/0363546514566191. Epub 2015 Jan 26. PMID: 25622987.
7. Cerminara AJ, LaPrade CM, Smith SD, Ellman MB, Wijdicks CA, LaPrade RF. Biomechanical evaluation of a transtibial pull-out meniscal root repair: challenging the bungee effect. Am J Sports Med. 2014 Dec;42(12):2988-95. doi: 10.1177/0363546514549447. Epub 2014 Sep 19. PMID: 25239930.
8. Kim JH, Chung JH, Lee DH, Lee YS, Kim JR, Ryu KJ. Arthroscopic suture anchor repair versus pull-out suture repair in posterior root tear of the medial meniscus: a prospective comparison study. Arthroscopy. 2011 Dec;27(12):1644-53. doi: 10.1016/j.arthro.2011.06.033. Epub 2011 Oct 7. PMID: 21982389.
9. Antao NA. Patterns of avulsions of posterior horn of medial meniscus. IJO 2000, VOL34(4);284-87.
10. LaPrade CM, James EW, Cram TR, Feagin JA, Engebretsen L, LaPrade RF. Meniscal root tears: a classification system based on tear morphology. Am J Sports Med. 2015;43(2):363-369. doi:10.1177/0363546514559684
11. Forkel P, Foehr P, Meyer JC, Herbst E, Petersen W, Brucker PU, Burgkart R, Imhoff AB. Biomechanical and viscoelastic properties of different posterior meniscal root fixation techniques. Knee Surg Sports Traumatol Arthrosc. 2017 Feb;25(2):403-410. doi: 10.1007/s00167-016-4237-4. Epub 2016 Jul 11. PMID: 27401006.
12. Brody JM, Lin HM, Hulstyn MJ, Tung GA. Lateral meniscus root tear and meniscus extrusion with anterior cruciate ligament tear. Radiology. 2006 Jun;239(3):805-10. doi: 10.1148/radiol.2393050559. PMID: 16714462.
13. Ozkoc G, Circi E, Gonc U, Irgit K, Pourbagher A, Tandogan RN. Radial tears in the root of the posterior horn of the medial meniscus. Knee Surg Sports Traumatol Arthrosc. 2008 Sep;16(9):849-54. doi: 10.1007/s00167-008-0569-z. Epub 2008 Jun 7. PMID: 18536902.
14. Koo JH, Choi SH, Lee SA, Wang JH. Comparison of Medial and Lateral Meniscus Root Tears. PLoS One. 2015 Oct 21;10(10): e0141021. doi: 10.1371/journal.pone.0141021. PMID: 26488288; PMCID: PMC4619510.
15. Lee SS, Ahn JH, Kim JH, Kyung BS, Wang JH. Evaluation of Healing After Medial Meniscal Root Repair Using Second-Look Arthroscopy, Clinical, and Radiological Criteria. Am J Sports Med. 2018 Sep;46(11):2661-2668. doi: 10.1177/0363546518788064. Epub 2018 Aug 17. PMID: 30118319.
16. Steineman BD, LaPrade RF, Santangelo KS, Warner BT, Goodrich LR, Haut Donahue TL. Early Osteoarthritis After Untreated Anterior Meniscal Root Tears: An in Vivo Animal Study. Orthop J Sports Med. 2017 Apr 27;5(4):2325967117702452. doi: 10.1177/2325967117702452. PMID: 28508006; PMCID: PMC5415046.
17. Rajkumar S. Amaravathi, Anoop Pilar, Sandesh G. Manohar, Madan Mohan Muniswamy, Fazal R. Rehman, Naveen J. Mathai . Arthroscopic management of neglected complex knee injury. Int J Res Orthop; Nov 2020(6):1327-1331. DOI: 10.18203/issn.2455-4510.IntJResOrthop20204607
18. Kim YM, Joo YB, Lee WY, Kim YK. Remodified Mason-Allen suture technique concomitant with high tibial osteotomy for medial meniscus posterior root tears improved the healing of the repaired root and suppressed osteoarthritis progression. Knee Surg Sports Traumatol Arthrosc. 2020 Jul 25. doi: 10.1007/s00167-020-06151-w. Epub ahead of print. PMID: 32712682.
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How to Cite this article: Amaravathi RS. Review of Meniscus Root Injury. Journal of Clinical Orthopaedics July-December 2020;5(2):41-44.

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A rare case report of chronic osteomyelitis of ulna with global involvement in an infant: A management perspective using Modified Masquelet technique with “Atmanirbhar” Gentamycin beads

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page:45-48 | Rajesh Lalchandani, Gaurav Garg, Rakesh Parmar, Rajesh kumar Yadav


Author: Rajesh Lalchandani [1], Gaurav Garg [1], Rakesh Parmar [1], Rajesh kumar Yadav [1]

[1] Department of Orthopedics, P.D. Hinduja National Hospital & MRC, Veer Savarkar Marg, Mahim West, Mumbai – 400016

Address of Correspondence
Dr. Vivek Shetty,
Department of Orthopedics, P.D. Hinduja National Hospital & MRC, Veer Savarkar Marg, Mahim West, Mumbai – 400016
E-mail: vivshetty7777@gmail.com


Abstract

Chronic osteomyelitis treatment has always been a serious challenge for an orthopaedic surgeon to treat and it needs dedication, perseverance and multiple operations for its complete cure. We hereby report a case of a one year female who presented to us with chronic osteomyelitis ulna with global involvement. The case was successful managed by debridement, excision of sequestered ulna and insertion of locally made gentamycin beads mounted on kirschner wire as a cement spacer in the first stage. After 4 weeks, removal of gentamycin beads was done followed by visualization of membrane formation and fibular grafting mounted on a k wire for stabilization. During follow-up, we observed good uptake of the graft at both the ends and regeneration of the fibula at donor site with no signs of recurrence of osteomyelitis. We are reporting this case because of its unique global involvement of ulna and use of modified Masquelet technique using gentamycin beads(rather than a blob of cement) on a wire as cement spacer and also as a tool for local delivery of antibiotics.
Keywords: Chronic Osteomyelitis, Modified Masquelet technique, gentamycin beads, diaphyseal osteomyelitis


References

1. Chadayammuri, Vivek et al. “Innovative strategies for the management of long bone infection: a review of the Masquelet technique.” Patient safety in surgery vol. 9 32. 14 Oct. 2015, doi:10.1186/s13037-015-0079-0
2. Careri, S. & Vitiello, Raffaele & Oliva, M.S. & Ziranu, A. & Maccauro, G. & Perisano, Carlo. (2019). Masquelet technique and osteomyelitis: innovations and literature review. European review for medical and pharmacological sciences. 23. 210-216. 10.26355/eurrev_201904_17495
3. Dreyfuss U. Acquired radial club hand. A case report. Hand. 1977;9:268-71.
4. D. Bettin, H. Böhm, M. Clatworthy, D. Zurakowski, T.M. LinkRegeneration of the donor side after autogenous fibula transplantation in 53 patients: evaluation by dual x-ray absorptiometry Acta Orthop Scand, 74 (2003), pp. 332-336
5. A.H. Krieg, F. HeftiReconstruction with non-vascularised fibular grafts after resection of bone tumours J Bone Joint Surg Br, 89 (2007), pp. 215-221
6. C.W. Steinlechner, N.C. MkandawireNon-vascularised fibular transfer in the management of defects of long bones after sequestrectomy in children J Bone Joint Surg Br, 87 (2005), pp. 1259-1263.


How to Cite this article: Shekhar S, Shetty V, Wagh Y. Challenges and Difficulties faced by Orthopedic Surgeons during the COVID-19 Pandemic: A Review of Modified Surgical Protocols. Journal of Clinical Orthopaedics July-Dec 2020;5(2):45-48.

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Pre fixation compression screw as a cutting-edge technique for varus correction during proximal femoral nailing for intertrochanteric fractures: a study on 46 cases

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page: 6-12 | Mithun Shetty, Shashi Kumar M.S, Shree Krishnananda Sagar


Author: Mithun Shetty [1], Shashi Kumar M.S [1], Shree Krishnananda Sagar [1]

[1] Department of Orthopaedics AJ Institute of Medical Sciences, Mangalore 575004

Address of Correspondence
Dr. Shashi Kumar,
room no #707, resident hostel aj institute of medical sciences, kuntikana, mangalore 575004
E-mail: shashikumar859@gmail.com


Abstract

Background: Achieving reduction prior to fixation is a key aspect in successfully managing intertrochanteric fractures. In this study of proximal femoral nailing for intertrochanteric fractures, a novel technique of utilizing prefixation compression screw was introduced to achieve and maintain reduction of femoral neck shaft angle.
Materials and Methods: The current prospective study was conducted over a period of six months between July 2018 and January 2019 among patients who underwent surgical fixation by PFN for intertrochanteric fractures of femur. Prefixation compression screw was used in all the cases to achieve and maintain correction of varus. Pre-operative, intra-operative and post- operative neck shaft angles were documented. Data was analysed by using Statistical Package for Social Sciences (SPSS). The results were expressed as percentages and graphs.
Results: There is significant improvement in correction of varus (average increase of neck shaft angle =14.04 degrees) with the use of prefixation screw technique. This procedure did neither increase the blood loss (average blood loss = 34.67 ml) during the procedure nor the duration (average duration = 19.46 mins) of the procedure.
Conclusion: Prefixation compression screw can be used as an effective alternative for varus correction in cases of simple intertrochanteric fractures undergoing PFN fixation with added intra-op and post-op advantages compared to other methods of reduction.
Keywords: Intertrochanteric fractures,Proximal Femoral nailing, Prefixation screw, Varus correction


References

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2. Voleti PB, Liu SY, Baldwin KD, Mehta S, Donegan DJ. Intertrochanteric Femur Fracture Stability: A Surrogate for General Health in Elderly Patients?. Geriatric orthopaedic surgery & rehabilitation. 2015 Sep;6(3):192-6.
3. Pathania VP, Sharma M, Gupta S, Kaushik SK. Management of intertrochanteric fracture by PFN Vs DHS: a comparative study. Journal of Evolution of Medical and Dental Sciences. 2015 May 14;4(39):6741-51.
4. Rajarajan NS. A comparative study of treatment of unstable intertrochanteric fractures with PFN and cemented hemiarthroplasty. International Journal of Orthopaedics. 2018;4(2):111-5.
5. Marmor M, Liddle K, Buckley J, Matityahu A. Effect of varus and valgus alignment on implant loading after proximal femur fracture fixation. European Journal of Orthopaedic Surgery & Traumatology. 2016 May 1;26(4):379-83.
6. Chang WS, Zuckerman JD, Kummer FJ, Frankel VH. Biomechanical evaluation of anatomic reduction versus medial displacement osteotomy in unstable intertrochanteric fractures. Clin Orthop Relat Res. 1987;(225):141-6.
7. Desjardins AL, Roy A, Paiement G, et al. Unstable intertrochanteric fracture of the femur: a prospective randomised study comparing anatomical reduction and medial displacement osteotomy. J Bone Joint Surg Br. 1993;75(3):445-7
8. Jonnes C, Shishir SM, Najimudeen S. Type II intertrochanteric fractures: proximal femoral nailing (PFN) versus dynamic hip screw (DHS). Archives of Bone and Joint Surgery. 2016 Jan;4(1):23.
9. Bakshi DA, Kumar DP, Brar DB. Comparative study between DHS and PFN in intertrochanteric fractures of femur. IJOS. 2018;4(1):259-62
10. Kyavater BS, Gupta S. Comparative study between dynamic hip screw vs Proximal femoral nailing in unstable inter-trochanteric fractures of the Femur in adults. JOURNAL OF EVOLUTION OF MEDICAL AND DENTAL SCIENCES-JEMDS. 2015 Jun 22;4(50):8690-3
11. Chun YS, Oh H, Cho YJ, Rhyu KH. Technique and early results of percutaneous reduction of sagittally unstable intertrochateric fractures. Clinics in orthopedic surgery. 2011 Sep 1;3(3):217-24
12. Lourenço PR, Pires RE. Subtrochanteric fractures of the femur: update. Revista Brasileira de Ortopedia. 2016 Jun;51(3):246-53
13. Kulkarni GS, Limaye R, Kulkarni M, Kulkarni S. Intertrochanteric fractures. Indian journal of Orthopaedics. 2006 Jan 1;40(1):16.
14. Siddiqui YS, Khan AQ, Asif N, et al. Modes of failure of proximal femoral nail (PFN) in unstable trochanteric fractures. MOJ Orthop Rheumatol. 2019;11(1):7‒16. DOI: 10.15406/mojor.2019.11.00460
15. K Şemmi, A Taşkın, K Cemil, et al. Mechanical failures after fixation with proximal femoral nail and risk factors. Clin Interv Aging. 2015;10:1959– 1965
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How to Cite this article: Shetty M, Kumar M.S.S, Sagar SK.Pre fixation compression screw as a cutting-edge technique for varus correction during proximal femoral nailing for intertrochanteric fractures: a study on 46 cases. Journal of Clinical Orthopaedics July-Dec 2020;5(2): 6-12.

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Mature Spinal Cord Teratoma In Adults: Report Of Two Unusual Cases And Literature Review

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page:49-52 | Sapan Kumar, Sanjeev kumar, Mohit Kumar Patralekh, Ramesh Kumar


Author: Sapan Kumar [1], Sanjeev kumar [1], Mohit Kumar Patralekh [1], Ramesh Kumar [1]

[1] Department of Orthopaedics, VMMC & Safdarjung Hospital, Delhi-110029, India

Address of Correspondence
Dr. Sapan Kumar,
Department of Orthopaedics, VMMC & Safdarjung Hospital, Delhi-110029, India
E-mail:- sapan2576@gmail.com


Abstract

Background: Teratoma is a germ cell tumour that is composed of a variety of parenchymal cell types derived from all three germinal layers (ectoderm, mesoderm, and endoderm). Spinal teratomas are very rare. Only 0.15-0.18% of spinal tumours have been classified as teratomas. We report two cases of spinal cord teratoma managed surgically, with good outcome.
Case reports: A 23 year old female presented with back pain and right lower limb weakness. She was evaluated by blood and radiological investigation. T12 through L2-3 flip laminoplasty with fixation was performed and the tumour was totally removed. The postoperative course was excellent, and histopathologically, numerous fatty cysts consisting of neuroepithelial and epithelial tissues were observed. The final diagnosis was that of a mature cystic teratoma.
Another 22 year old male, was presented with back pain for six months. He was evaluated by blood and radiological investigation. Total resection of the tumour by means of L2 – L3 laminectomy was done. Ectodermal, mesodermal and endodermal
elements were revealed. The final histopathological diagnosis was that of a mature cystic teratoma.
Conclusion: Although intramedullary teratomas are very rare in adults, they need to be considered in differential diagnosis. The present study also compares the literature
concerning adult intradural mature teratoma, summarises the basic clinical characteristics and theory of origin of adult intradural mature teratoma and reviews the available treatment options for this disease.
Key words: Intradural; Intramedullary; Spinal Cord; Teratoma; Adult.


References

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How to Cite this article: Kumar S, kumar S, Patralekh MK, Kumar R. Mature Spinal Cord Teratoma In Adults: Report Of Two Unusual Cases And Literature Review. Journal of Clinical Orthopaedics July-Dec 2020;5(2):49-52.

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Clinical outcomes of patients undergoing Minimally Invasive Plate Osteosynthesis (MIPO) for distal tibia fractures

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page: 2-5 | Shikhar D Singh, Sachin Y Kale, Adnan Asif, Jay Parsania, Atul Jain, Prasad Chaudhari


Author: Shikhar D Singh [1], Sachin Y Kale [1], Adnan Asif [2], Jay Parsania [1], Atul Jain [3], Prasad Chaudhari [1]

[1] Department of Orthopedics, DY Patil University School of Medical, Nerul, Navi Mumbai
[2] Department of Orthopedics, Christian Medical College, Vellore
[3] Department of Orthopedics, Deep Chand Bhandu Hospital, New Delhi

Address of Correspondence
Dr. Sachin Y Kale,
Department of Orthopaedics, DY Patil University School of Medical
Sector 7, Nerul, Navi Mumbai – 400706
E-mail: drsinghshikhar@gmail.com


Abstract

Introduction: Distal tibial fracture being subcutaneous poses a surgical challenge and can be complicated with delayed union, non-union, wound infection and wound dehiscence. Minimally Invasive Plate Osteosynthesis (MIPO) of distal fractures is indicted for displaced or unstable fractures due to its technical advantages and satisfactory clinical outcomes.
Methodology: We prospectively studied consecutive adult patients with closed distal tibia fracture treated with locking plates with MIPO technique. We included consecutive patients with Gustillo type 1 closed fracture with or without articular extension. Clinical outcome was assessed using Olerud and Molander Score (OAMS). Radiographic assessment was done to assess for radiological union.
Results: Among the 30 patients, right side was involved in 53% of the patients and the most common type of fracture was 43.A1 type (47%). OAMS done post-operatively found that 67% had excellent outcome, 27% had good outcome, 6% and fair and none of the patients had poor clinical outcome. Radiological union was achieved in 12 weeks in 20%, 12 to 16 weeks in 23%, 16 to 20 weeks in 50% and 20 to 24 weeks and 24 to 28 weeks in one patient each. Superficial wound infections was observed in five patients, ankle stiffness in four patients and delayed union in two patients.
Conclusions: Results of our study show that locking compression plate using MIPO technique does not compromise the periosteal blood supply and does not rely on the compression between the plate and the bone. Thus MIPO is an effective treatment for tibial diaphysis and distal tibia fractures.
Keywords: Distal tibial fractures, locking plate, Minimally invasive percutaneous plate osteosynthesis


References

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How to Cite this article: Singh SD, Kale SY, Asif A,Parsania J, Jain A, Chaudhari P. Clinical outcomes of patients undergoing Minimally Invasive Plate Osteosynthesis (MIPO) for distal tibia fractures. Journal of Clinical Orthopaedics July-Dec 2020;5(2):2-5.

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Partial Rotator Cuff Tears: a review of the literature

Journal of Clinical Orthopaedics | Vol 5 | Issue 2 |  July-Dec 2020 | page:30-34 | Stefania Kokkineli, Emmanouil Brilakis, Emmanouil Antonogiannakis


Author: Stefania Kokkineli [1], Emmanouil Brilakis [1], Emmanouil Antonogiannakis [1]

[1] Department of Orthopaedic, HYGEIA Hospital. MD. Erythrou Stavrou 4, Marousi 15123

Address of Correspondence
Dr. Stefania Kokkineli,
Department of Orthopaedic, HYGEIA Hospital. Athens, Greece
Address: Erythrou Stavrou 4, Marousi 15123. Greece
E-mail: stephaniekokkineli@gmail.com


Abstract

Partial- thickness rotator cuff tears are the most common cause of shoulder pain in adults and have been classified into subtypes according to location and depth. The frequency rate and tear size progression increase with age, tobacco use and medical comorbidities. Partial tears are divided into tears of acute, chronic or acute-on-chronic onset. Surgical treatment is indicated in symptomatic patients with persistent pain after failed conservative treatment of at least 3 months, mainly with tears that exceed 50% of the tendon thickness. Arthroscopic repair techniques include in situ and tear completion repair. Authors’ preferred technique for in situ repair is described followed by the postoperative rehabilitation protocol. The surgical techniques described have various advantages and disadvantages with regard to intra- operative complications, clinical outcomes, recovery time and re-tear rates which make it difficult to decide on which technique to use. The option is a matter of surgical indications, philosophy and skills.
Keywords: Partial-thickness rotator cuff tears, transtendon repair, in-situ repair, shoulder, arthroscopy


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How to Cite this article: Kokkineli S, Brilakis E, Antonogiannakis E. Partial Rotator Cuff Tears: a review of the literature. Journal of Clinical Orthopaedics July-Dec 2020;5(2):30-34.

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