Journal of Orthopedic Education

Introduction: Radial head is an important stabilizer of the elbow. Although preservation of the fractured radial head has biomechanical advantages, comminuted fractures belonging to Mason type III usually do not have satisfactory outcome after osteosynthesis. Excision of the fractured head also often renders the elbow unstable. Therefore, radial head replacement by a prosthesis has been under study as an alternative option. Material and Methods: Seventeen patients with
Mason type III radial head fractures treated by cemented mono-block radial head prosthesis were retrospectively studied. Their clinical and functional outcomes were analysed. Results: Functional results were studied in the 15 available patients using the Mayo Elbow Performance
Score. Seven patients had good or excellent results; six had fair and two had poor outcomes. None had infection, instability, or implant loosening by the end of three years of follow-up. Conclusion: Considering the unpredictable outcomes of osteosynthesis in comminuted radial head fractures, cemented prosthetic replacement using the metallic mono-bloc prosthesis is a viable surgical option in these patients with satisfactory results.

Keywords: Radial head; Comminuted fracture; Prosthesis; Radial head replacement.
 

Context: Osteochondral defect (OCD) of the articular cartilage of the knee is difficult to manage and leads to recurrent episodes of pain, stiffness and finally early onset osteoarthritis. The condition is common in young individuals and is often difficult to be identified by routine clinical examination and radiographs. Thus a high index of suspicion, advanced imaging or diagnostic arthroscopy is important. There are differing opinions regarding effective surgical management. Our study is a case series of management of osteochondral defect in the knee using autologous cartilage chip graft from non weight bearing site. Aim: To evaluate the clinical outcome role of surgical management of osteochondral injuries of knee with cartilage autograft from non-articular surfaces. Settings and design: Case series. Level of evidence IV. Materials and methods: A prospective clinical evaluation of 9 patients
was done in Department of orthopaedics at the KLE’S Dr. Prabhakar Kore hospital & MRC, Belagavi. Patients in the age group of 18 to 50 years of either sex presenting to the out-patient department of orthopedics with features of suspected osteochondral defect of either knee were included. Nine cases that are fulfilling the inclusion/ exclusion criteria were selected. These patients were subjected to magnetic resonance imaging (MRI) with findings confirmed intraoperatively. All patients underwent surgical intervention with cartilage autograft from non weight bearing areas. Pre- and post-operative outcome were measured using Visual analogue score and Lysholm score with one year follow-up. Results: The mean age of patients affected in our study was 32.7 years. In our study males (77.7%) were more commonly affected than females (22.3%). Right knee (55.5%) was more commonly affected. The mean of maximum size of the osteochondral defect by MRI was 2.2 cm. Follow-up was done at 6 weeks, 12 weeks, 6 months and at 1 year. There was statistically significant difference in decrease of VAS score and Lysholm score in all the patients. Interpretation and conclusion: In our study, osteochondral autograft transplantation demonstrated both good short and long term outcomes as assessed by the visual analog scale score and Lysholm score. Thus the study concludes that osteochondral autograft transplantation provides good pain relief and can be considered a safe and effective treatment option.

Keywords: Osteochondral defect; Mosaicoplasty; Autologous cartilage graft.
 

Introduction: Supracondylar fracture of humerus is most common of all the fractures around the elbow in children. They occur most commonly during the childhood in male child with the peak around 5-8 years. The neurovascular injuries are more common in this fracture type. Aim and
Objective:To study the incidence and outcome of nerve injuries in supracondylar fracture of humerus. Materials and methods: A4 yearretrospective analysis was done among children with supracondylar
fracture of humerus for nerve injuries. All the nerve injuries were documented and categorized. The type of fracture and the treatment given for the children with nerve palsy were recorded and analyzed. The follow up of the children were analyzed to know the complete/partial recovery of the nerve. Results: Out of 22 children,8 children had traumatic, 1 unknown and 13 had iatrogenic nerve palsies in this study. The incidence rate of nerve palsy in our study was 13.92%. Radial, ulnar and median nerve palsy were seen in 7, 11 and 2 children. 2 patients who had open fracture developed both median and radial nerve palsy. The average nerve recovery rate for median, ulnar and radial nerve were3.25, 3.63 and 3.7 months. Conclusion: The chances of nerve palsy should be kept in mind in the treatment of supracondylar fracture and proper counselling should be given pre-operatively. Ulnar nerve was most commonly injured and median nerve was most early to recover in our study.

Keywords: Supracondylar Humerus fractures; Elbow; Kirschner Wires; Ulnar nerve; Median nerve; Radial nerve.
 

Context: Lateral epicondylitis is a micro-tear most often within the origin of the extensor carpi radialis brevis. It has an incidence of 4 to7 persons per 1000 general population per year. Aim: To compare the efficacy of Platelet Rich Plasma(PRP) with corticosteroid in treatment of lateral epicondylitis.Settings and Design: A hospital based randomized control trial. Statistical analysis used: Mean, Standard deviation and Mann Whitney test. Materials and methods: One year randomized control trial was done in the Department of Orthopaedics at the KLES Dr. Prabhakar Kore Hospital & MRC, Belagavi. Patients in the age group of 30 to 55 years of either sex who were fulfilling the inclusion/ exclusion criteria presenting to the out-patient department of orthopedics with lateral epicondylitis of either limb were included and randomized into catergory 1 (corticosteroid injection) and category 2 (PRP injection). Category 1(n=30) patients were subjected to local corticosteroid injection and category 2(n=30) were subjected to Platelet Rich Plasma and outcome measured using Visual analogue score(VAS) and NIRSCHL staging.
Results: At 2 weeks corticosteroid demonstrated significant decrease in VAS score and NIRSCHL staging. At 6 weeks both categories had similar results. At 12 weeks and 6 months follow-up, there was significant decrease of VAS score and NIRSCHL score in the PRP category.Conclusion: Thus the study concludes that though local injection of steroids provide good pain relief in short term, platelet rich plasma is better for longer pain free period.

Keywords: Lateral epicondylitis; Corticosteroid; Platelet rich Plasma.