Journal of Orthopedic Education

Congenital dislocation (CDH) of the hip joint (now falling under the umbrella term Development Dysplasia of hip (DDH) has a high incidence in the Indian subcontinent. Even though the number of reported bilateral CDH cases are comparatively less, a large number go under the radar due to similar presentations on both sides due to which a medical opinion is not sought by the parents until the walking age. Herein lies the need for a more extensive screening protocol. Such cases, when presented late, require surgical correction in cases where conservative management becomes redundant. Literature is divided on the course of management of such cases and we wish to present one such case here.

Keywords: CDH, Congenital Subluxation of HIP, Derotational Osteotomy of HIP.

Tibiotalocalcaneal arthrodesis using a supracondylar femoral nail for advanced tuberculous arthritis of the ankle had been described by Gavaskar et al. in 20097. We describe here our experience with patients who underwent arthrodesis of the ankle using a supracondylar femoral nail for pain and/or instability resulting from post-traumatic avascular necrosis. All the three patients had undergone tibiotalocalcaneal arthrodesis using a short supracondylar femur nail between September 2017 and March 2019. At postoperative year one, the mean FAOS for pain improved to 76 from 25, whereas the mean FAOS for quality of life improved to 63 from 11. We achieved our intended goal of obtaining a tibiotalocalcaneal arthrodesis using a supracondylar femoral nail with satisfactory functional outcomes. Tibiotalocalcaneal arthrodesis using a supracondylar femoral nail appears to be an acceptable solution as a low-cost procedure in patients requiring ankle fusion.

Keywords: Ankle arthrodesis; Avascular necrosis; Supracondylar femoral nail

Introduction: Ankle joint is highly congruous and any disturbance of the normal articular relationship may result in some progressive arthrosis of biomechanical dysfunction. Malleolar fractures are one of the most common fractures in orthopaedic traumatology. As with all intra articular fractures, malleolar fractures necessitate accurate reduction and stable internal fixation. This study was therefore performed to study the functional outcome and results of surgical treatment of bimalleolar fractures and to know the complications of open reduction internal fixation of bimalleolar fractures. Materials and methods: 30 patients who came to the emergency ward in our hospital with fresh bimalleolar fractures were included into the study. The lower end of tibia fibula including both malleoli, calcaneus and talus were examined and looked for local bony tenderness and bony irregularities, displacement, on natural mobility crepitus, inter relation of malleoli, springing of fibula, dorsalis pedis and posterior tibial artery pulsations were checked and noted. After the surgery, the patients were followed up until the union was complete. Results: The mean age of our study was 40 years with 73% of the patients being male. The most common mode cause of injury was road traffic accidents affecting 15 (50%) of the people, while slipping was the cause in 13 cases. The most common type of injury was Supination external rotation affecting 40% of the patients, followed by pronation abduction in 20% of the patients. 16.7% of the patients were affected by pronation external rotation and 113.3% of them had supination adduction. In the present study, 13 (43.3%) had no pain and 14 (46.7%) patients had grade B i.e. pain with strenuous activities and remaining 3 (10%) had pain with activities of daily living. In the present study of 30 patients with bimalleolar ankle fractures treated by open reduction and internal fixation. Excellent results were achieved in 13 (43%), good in 10 (33%), fair in 6 (20%) and poor in 1 (3%) of patients. The patients with poor result had mild pain with activities of daily living, diminution in the abilities to run/work, reduced ankle movements and decreased joint space. Conclusion: Open reduction and internal fixation in accordance with AO principles was an efficient way to manage Bimalleolar Ankle Fractures.

Keywords: Bimalleolar Ankle Fractures; Open reduction; Internal fixation

Introduction: Due to its special location, it is difficult to perform open reduction and internal fixation, if early effective treatment is not provided for patients, chronic collapse often occurs, which leads to significant limited range of knee flexion and extension. It is pivotal to find an approach with more accurate exposure of fracture and more operable fixation to obtain better outcome of treatment for PTPF. Aim: to evaluate the outcome of prone and direct posterior approach for management of posterior column tibial plateau fracture in terms of clinic radiological and functional outcome. Material and methods: Prospective hospital based descriptive study conducted in Department of Orthopedics in teaching hospitals attached to SMS Medical College and Hospital from January 2017 to May 2018, on 36 subjects. Patients were seen for clinical and radiological assessment at 15 days, 3rd month and 6th months interval and outcome analysed by Lysholm score, Tegner score and RUST criteria for radiological union. Observation: There was a significant increase in the scores 1.17 ± .97; p <0.001S in Tegner score between 3 month and 15 days. Significant improvement (6.00 ± .93; p <0.001S) was observed in score on applying paired-samples t- to compare Lysholm Score between 6 month and 15 daysThere was a significant increase in the RUST criteria between 6 month and 3 month scores 3.47 ± 1.44; p < 0.001S. These results suggest that operation really effective for improvement of the disease conditions. Conclusion: Using the prone posterior approach with a reverse L-shaped incision to manage fragments of the posterior column in tibial condylar fractures can achieve anatomic reduction and rigid fixation, resulting in a good functional outcome by buttressing the posteromedial fragment by plate and buttress effect preventing descent of the fragment under load than other modes of fixation.

Keywords: Prone posterior approach; Tibial condylar fractures; Lysholm Score; RUST criteria

Aim: The aim of the current research is to assess the functional outcome of proximal humerus fractures treated by locking compression plate. Materials & Methods: Present Prospective research including subjects who are above 18 years with proximal humerus fractures admitted to tertiary care institute of Bhuj, Kutch. Sixty cases of fractures of proximal humerus were operated by open reduction and internal fixations with Locking Compression Plate were assessed. Results: Most of the subjects in the present study were males, old aged, with Road Traffic Accidents being the most common form of injury, concerning 2 part, 3 part and 4 part fractures of x proximal humerus. The fractures united in all 30 patients. Excellent and satisfactory results were observed in 76.7% of patients with unsatisfactory results in 23.3% according to Neer’s criteria. There were 100% union rates and negative failures. Conclusion: Compression plate is an beneficial implant in proximal humeral fractures owing to angular stability, predominantly in comminuted fractures and in Osteoporotic bones in elderly patients, consequently permits early mobilization.

Keywords: Proximal Humerus Fractures; Open Reduction; Internal Fixation

Background: Multiple treatment modalities have been reported for managing such cases like bone grafting, tissue transfers, antibiotic cement and Ilizarov technique. Bone grafting itself poses limitations of size and morbidity of the donor site. The aim of the present study was to determine the accuracy of Ilizarov technique in managing non-united infected tibial fractures. Materials and Methods: The present prospective study was conducted in the Department of Orthopaedics, Mata Gujri Memorial Medical College, Kishanganj, Bihar (India) for duration of 2 years. All the subjects were followed up for a period of 10 months. Under complete aseptic conditions, all the subjects were taken up for surgery. Debridement of the area was done, and the material was sent for sensitivity tests. Bone nibbling was performed until fresh bleeding was encountered. At regular intervals, X-rays were taken to determine the radiological extent of bone healing. Assessment was done based on Fernandez Esteve grading. In case of any discharge from the tract, infected pin was removed and exchanged in the same sitting. Once healing was satisfactory, ring and fixator were removed, and cast was applied. Results: The mean age of the subjects was 38.87 ± 3.22 years. There were 13 males (59.1%) and 9 females (40.9%) in the study. There were 3 males and 2 females with bone shortening of 1–3 cm. The union time amongst them was 6 weeks and the consolidation time was 9–10 months. Conclusion: Treatment using Ilizarov method with infected tibial fractures provides promising results. Optimal fixation was seen amongst subjects in the present study.

Keywords: Consolidation; Fractures; Ilizarov; Infected.