Clinical Outcome of Patella Stability after Fixation of Osteochondral Fracture in Acute Primary Traumatic Patella Dislocation Without MPFL Repair or Reconstruction

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Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 110-115 | Mukesh Laddha, Anshul Pancholiya, Sahu Gaurav

DOI: 10.13107/jcorth.2022.v07i01.489

Author: Mukesh Laddha [1], Anshul Pancholiya [2], Sahu Gaurav [3]

[1] Department of Robotic Joint Replacement and Arthroscopy, RNH Hospital, Nagpur, Maharashtra, India.
[2] Department of Adult Reconstruction and Sports Medicine, RNH Hospital, Nagpur, Maharashtra, India.
[3] Department of Orthopaedic Surgery, Dhamtari Christian Hospital, Dhamtari, Chhattisgarh, India.

 

Address of Correspondence
Dr. Mukesh Laddha,
Department of Robotic Joint Replacement and Arthroscopy, RNH Hospital, Balraj Marg, Dhantoli, Nagpur, Maharashtra, 440012, India.
E-mail: drmsl1812@gmail.com

Abstract

Introduction: Conservative management is advisable for acute primary traumatic patella dislocation (PTPD). Surgical treatment is reserved for osteochondral fractures (OCF), medial patello femoral ligament (MPFL) avulsion/tear, compound injuries, and any underlying bony abnormalities requiring correction. MPFL repair (at avulsed site) or reconstruction along with underlying bony correction in PTPD is controversial. The purpose of this study is to evaluate patella stability after fixation of OCF in PTPD without performing MPFL repair or reconstruction, even in the presence of any underlying bony abnormalities.

Material and Methods: This is a retrospective study of eight patients who had PTPD with OCF along with MPFL injury who presented between 2016 and 2019. Pre-operative X-rays and MRI were done to assess the status of MPFL, identify the presence of OCF and to calculate Insall-Salvati index, Tibial Tuberosity-Trochlear groove distance and Trochlear dysplasia. All patients underwent surgery by open approach and OCF fixation by bioabsorbable pins or suture material. MPFL was neither repaired at avulsed site nor reconstructed and even no bony corrections were done.

Results: Average size of OCF fragments is 15*7 mm and all involving medial facet of patella. Lysholm score improved significantly from 32.8 to 94.8 and Kujala score from 49.1 to 96 at the end of 6 months. None of the patient had patella instability till latest follow-up, average follow-up period is 4.5 years (3–6 years). Clinically, apprehension test was negative in all cases with full ROM. Post-operative imaging including X-ray and MRI showed complete healing of the OCF along with complete healing/regeneration of MPFL with same pre-existing bony abnormalities if present preoperatively.

Conclusion: This study shows excellent patella stability and full knee function along with complete union of OCF and complete healing/regeneration of MPFL in PTPD even in the presence of underlying bony abnormality. Hence, in PTPD with OCF, there is no need to repair/reconstruct MPFL or to correct underlying bony pathology, only OCF fixation is required.

Keywords: Patella dislocation, traumatic osteochondral fracture, medial patello femoral ligament, Lysholm and Kujala score

References

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How to Cite this article: Laddha M, Pancholiya A, Gaurav S. Clinical outcome of patella stability after fixation of osteochondral fracture in acute primary traumatic patella dislocation without MPFL repair or reconstruction. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):110-115.

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A systematic review and meta-analysis: Postoperative outcome comparison of intramedullary nailing and external fixation in charcot neuroarthropathy

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Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 60-63 | Cok Gde Oka Dharmayuda, Dewa Gede Bracika, Kenji Arnaya, Sri Mahadana, Putu Teguh Aryanugraha, Benedictus Deriano, Nariswati Anggapadmi Wiraputri, I Ketut Gede Surya Pranata

DOI:10.13107/jcorth.2022.v07i01.473

Author: Cok Gde Oka Dharmayuda [1], Dewa Gede Bracika [2], Kenji Arnaya [2], Sri Mahadana [2], Putu Teguh Aryanugraha [2], Benedictus Deriano [2], Nariswati Anggapadmi Wiraputri [2], I Ketut Gede Surya Pranata [2]

[1] Consultant of Orthopaedic and Traumatogy Department, Faculty of Medicine Udayana University, Indonesia.

[2] Resident of Orthopaedic and Traumatogy Department, Faculty of Medicine Udayana University, Indonesia.

Address of Correspondence
Dr. Cok Gde Oka Dharmayuda,
Diponegoro St., Dauh Puri Klod, Kec. Denpasar Bar., Kota Denpasar, Bali 80113, Indonesia.
E-mail: suthenoandrew@gmail.com

Abstract

Charcot neuropathic osteoarthropathy or neuroarthropathy of the foot and ankle is due to sensory and motor neuropathies which lead to a chronic and progressive destruction of the foot architecture involving bones, joints, and soft tissues. The aim of the present study was to compare the results of EF and retrograde IMN in ankle arthrodesis for patients with Charcot neuroarthropathy of the ankle joint. This study conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analysis statement. Literature Search was done on using the databases of PubMed, EMBASE, and Cochrane Library were systematically retrieved. From the selected databases, 205 references were obtained. By screening the titles and abstracts, 48 references were excluded The remaining potentially relevant 12 studies underwent a detailed and comprehensive evaluation. Finally, five studies were included in our meta-analysis. Based on the report in this meta-analysis, IMN could showed better results compared to EF for Charcot joint arthrodesis, with IMN showing higher rate of fusion, and lesser risk of complication.

Keywords: Systematic Review, Meta-analysis, Charcot Neuroarthropathy, Intramedullary Nailing, External Fixation

References

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How to Cite this article: Dharmayuda CGO, Bracika DG, Arnaya K, Mahadana S, Aryanugraha PT, Deriano B, Wiraputri NA, Pranata IKGS. A systematic review and meta-analysis: Postoperative outcome comparison of intramedullary nailing and external fixation in charcot neuroarthropathy. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):60-63.

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Thoracolumbar kyphosis in siblings of Mucopolysaccharidosis: A case report

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Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 116-121 | Sharvin Sheth, Amit Jhala

DOI: 10.13107/jcorth.2022.v07i01.491

Author: Sharvin Sheth [1], Amit Jhala [1]

[1] Department of Spine Surgery, HCG Hospitals, Ahmedabad – 380006, India

 

Address of Correspondence
Dr. Amit Jhala,
Consultant Spine Surgeon and Chief, Department. of Spine Surgery, HCG Hospitals, Mithakali 6-roads, Ahmedabad, 380006, India.
E-mail: acjhala@gmail.com

Abstract

Mucopolysaccharidosis (MPS) is a group of inherited metabolic disorders caused due to abnormal storage of mucopolysaccharides in different tissues of the body. They are autosomal recessive disorders, except MPS II which has an X-linked recessive pattern. Musculoskeletal manifestations occur due to disturbance in bone remodeling and improper development of ossification centers. Thoracolumbar kyphosis is the most common spinal pathology resulting from abnormal vertebral end plate ossification and growth arrest as well as hypotonia and spinal musculature imbalance. The increased life span as a result of medical treatment and lack of osseous penetration of enzyme replacement has raised the issue of thoracolumbar dysplasia and resultant deformity. Here, we discuss a case report of progressive thoracolumbar spinal deformity in two siblings suffering from MPS who underwent spine deformity correction surgeries, and literature review for the same.

Keywords: Mucopolysaccharidosis, spine deformity, scoliosis correction

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How to Cite this article: Sheth S, Jhala A. Thoracolumbar Kyphosis in Siblings of Mucopolysaccharidosis: A Case Report.. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):116-121.

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Navigate and Succeed: MI-Transforminal Lumbar Interbody Fusion with Three-Dimensional Navigation

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Journal of Clinical Orthopaedics | Vol 7 | Issue 1 |  Jan-Jun 2022 | page: 28-39 | Arvind G Kulkarni, Pradhyumn Rathi, Pritem A Rajamani

DOI:10.13107/jcorth.2022.v07i01.463

Author: Arvind G Kulkarni [1], Pradhyumn Rathi [1], Pritem A Rajamani [1]

[1] Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital, Mumbai, Maharashtra, India

Presented work performed at Saifee Hospital, Mumbai, India

Address of Correspondence
Dr. Arvind G Kulkarni,
Mumbai Spine Scoliosis and Disc Replacement Centre, Bombay Hospital, Mumbai, Maharashtra, India.
E-mail: drarvindspines@gmail.com

Abstract

Introduction: Lumbar Interbody Fusion (TLIF) has become a popular technique for achieving segmental interbody fusion and minimal access approach has its advantages. We have described the various Components in Spine Navigation Systems and how they have evolved in time and also describing our technique in detail. We have discussed on the advantages and disadvantages of the minimal access and use of Navigation.

Method: The authors ventured to assess the impact of 3D navigation in 117 patients that were treated with single level 3D navigated MI-TLIF in evaluating, Navigation setting time , Radiation exposure, Disc space preparation, Cage placement, Accuracy of pedicle screw placement, Cranial facet violation and Evaluation of canal decompression.

Result: Total time taken for setting up of navigation was 46.65±9.45 min. Average Radiation exposure was 5.69 mSv. In our study, the amount of disc removed was 75% in the ipsilateral anterior, 81% in ipsilateral posterior, 63% in contralateral anterior and 43% in contralateral posterior quadrants. The cage position was central in 87 patients, contralateral antero-central in six patients and ipsilateral postero-central in eight patients. The mean intraoperative blood loss was 89.65 ± 23.67 ml. Regarding accuracy 95.6% showed grade 0 and 4.4% had Grade 1 pedicle breach. Only 25 out of 408 pedicle screws (6.1%) violated the cranial facet joint. The navigation array probe was utilized to verify the adequacy of decompression and to confirm the anatomical landmarks. In our study, no surgical site infection was seen.

Conclusion: We find MIS to be associated with less post-operative infection rates as compared to open techniques. With 3D navigation, MIS becomes safer and highly accurate. MIS-TLIF with 3D navigation have satisfactory clinical outcomes and fusion rates with the additional benefits of less initial postoperative pain, less blood loss, earlier rehabilitation, and shorter hospitalization. MIS–TLIF with 3D navigation is a more cost-effective treatment than MIS-TLIF with fluoroscopy.

Keywords: Lumbar Vertebrae, Minimally Invasive Surgical Procedures, Neuronavigation, Spinal Fusion

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How to Cite this article: Kulkarni AG, Rathi P, Rajamani PA. Navigate and Succeed: MI-Transforminal Lumbar Interbody Fusion with Three-Dimensional Navigation. Journal of Clinical Orthopaedics Jan-Jun 2022;7(1):28-39.

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