Journal of Orthopedic Education

Hip joint is naturally a very stable joint and tends to require a significant amount of force to dislocate. Dislocation of hips usually occur in young individuals. Traumatic hip dislocations are common in high-energy automobile accidents. The amount of energy, position of hip at the time of trauma and its morphology determines the type of dislocation, its direction and the associated fractures. These factors are to be taken into consideration while assessing the case of hip dislocation in emergency. Such patients require a standard trauma evaluation, a thorough musculoskeletal and neurological examination and detailed radiographic evaluation. Here we present a case of 40-year-old man who sustained posterior hip dislocation with posterior wall acetabular fracture with lipo-hemarthrosis. Urgent open reduction and internal fixation of the posterior acetabular wall was done with recon plate and screws were done. To our knowledge, such injuries occur less often in the literature with such findings. Possible mechanisms of injury and operative procedures are discussed.

Wound healing is an array of carefully planned steps playing in a sequence to mettle the ill fate that nature has brought on the body. It includes inflammation, proliferation and remodelling. Wound healing depends on different growth factors, cytokines, interleukins and cell population for success. In this article we report how we have used different regenerative methods like the autologous platelet rich plasma, insulin therapy, prolotherapy, low level laser therapy for augmenting wound healing.

The keystone flap is a new flap design that has been added to the arsenal of cosmetic surgeons. The keystone flap is a type of flap that can be used to close soft tissue abnormalities using the local skin. It can be employed in a variety of situations. In the care of a keystone flap to repair a deficiency over the lower limb defect following a road traffic accident, we used closed incision negative pressure therapy.

Wound healing is complex process and has overlapping steps of haemostasis, the inflammatory and proliferative phases, remodelling. Problem with the edge of the wound can be detrimental to healing and can cause delay in wound healing. In this article, we share experience of using topical haemoglobin (Hb) spray for wound bed preparation in non-healing ulcer overlying the amputation stump.

Aims and objective: Fractures of tibia shaft are most common of long bone fractures. Proximal tibia fractures account for approximately 5% to 11% of all tibial injuries and affect knee function and stability in most of the cases. Higher rates of malunion and increased incidence of associated complications have made these fractures particularly problematic. This study was performed to compare functional outcome and duration of union of metaphyses diaphyseal fractures of tibia treated with Multidirectional Interlocking Intramedullary Nailing (ETN: Expert Tibia Nail) and Locking Compression Plating and achieve Restoration of axis, length, and rotation of the lower leg; Sufficient primary stability of the osteosynthesis for early functional aftercare to maintain joint mobility.

Methodology: We conducted a prospective study to know which definitive surgical treatment option (nailing or plating) is better for extra-articular proximal tibia fracture. Subjects who have sustained proximal tibia extra-articular fracture and who are admitted in Apollo Institute of Medical Sciences and Research, Chittoor were the sources. The Sample Size is 30. With 15 in each group (group A Plating and group B Nailing). The functional outcome was assessed using Klemm Borner Knee Scoring system during clinical follow-up at 6 weeks, 3 months and at 6 months post-surgery.

Results: Both Groups showed no significant difference in functional outcome assessed using Klemm Borner score, Klemm borner score in both groups initially at 6 weeks showed 26.7% good results in plating group and 33.3% good results in nailing group which progressed to give 60% excellent results in both groups and 26.7% good results in plating group and 33.3% in nailing group. Post-operative hospital stay (p = 0.043), postoperative infection rate (p = 0.036) were significantly high in the PTLCP group than in the IMN group, while rate of malunion (p=0.041) and non-union (0.037) were significantly high in IMN group than in PTLCP group. However there was no clear advantage of either technique in terms of functional recovery of knee.

Conclusion: Present comparison of IMN and MIPPO for the treatment of proximal one-third tibia fracture showed no clear advantage of either technique. Present study concluded that both forms of treatment (IMN and MIPPO) provide adequate fracture stability. Journal of Orthopedic Education 64 Volume 9 Number 1, January-April 2023 Considering lesser time for union, early weight bearing, lower chances of infection and lesser surgical duration, nailing seems to be more promising for extra articular proximal tibia fractures but Locking Compression Plating provides stable reduction in fractures like (AO41A2.2- simple metaphysical oblique fracture in sagittal plane)

The lymphedema is a chronic and progressive disease which is associated with symptoms like swelling, heaviness, pain, discomfort, maceration of interdigital spaces, skin change and frequent skin ulcerations. There is no one single treatment modality that can give 100% therapeutic outcome in patients with lymphedema. Complete decongestive therapy is the gold standard treatment with good therapeutic outcomes. In this article, we are sharing our experience of using low-level laser therapy as an adjuvant in the management of a patient with severe unilateral lower limb lymphedema.

Exudates in the wound is necessary for healing, but excess exudation needs to be managed for the wound to heal in an optimal manner. By addressing the underlying cause and by using appropriate wound dressing, the amount of exudate produced can controlled. Underlying systemic or local conditions like malnutrition, cardio-vascular, immunological or infection can impair the normal wound healing processes and lead to chronicity. A prolonged inflammatory response is seen in chronic wounds with increased levels of pro-inflammatory cytokines and excess amounts of exudate with increased protease level, which may inhibit healing by damaging the wound bed and surrounding skin. The chronic wounds treatment especially dressing of wounds imparts financial and physical burden to the health care facilities across the globe. There is always a need for a dressing material, which can address the excess exudate, the dead space, which can minimize the dressing changes and above all which is cost effective. In this article we share our experience of using a dress material with a newer technology called 3D fit technology. The novelty of this study is that, this material has very limited data available from India.

Osteoarthritis of the knee joint is the most common form of arthritis that cause pain, stiffness and decreased function. It is one of leading cause of disability in the Indian population. Many different methods are available to help the patients relieve their symptoms. Intra-articular steroid is one of them which is widely being used, but it has its own side effects. Further more, these treatments are generally intended to decrease pain, maintain or improve joint function and minimize disability but fail to regenerate the articular cartilage. Recent studies suggest an intra-articular injection of autologous PRP as an effective and safe biological treatment method in the initial stages of knee osteoarthritis.

Osteomyelitis is common following open fractures and is accentuated in the presence of devices like prosthetics or external fixators. It is most commonly caused by gram-positive bacteria. Fungal infections are rarely reported. This is the report of a case of zygomycosis of bone in an open fracture of femur with exposed knee joint with external fixator and proximal femoral nailing.

Reconstruction of the lower extremity is a complex task that has evolved greatly in both technique and indication over the past century. Early advances in treating traumatic lower extremity injuries focused on primary amputation to avoid the high mortality of infection. The introduction of antibiotics improved surgical debridement and local reconstructive options, enhancing the viability of lower extremities with simple and proximal defects. With the advent of microvascular surgery, free tissue transfer techniques provided a means to reconstruct more distal and complex problems. As these surgical techniques have continued to evolve, so too have indications for reconstruction, patient management and post-operative care-now with a greater emphasis on patient quality of life and limb function. The purpose of this article is to outline the evolution of lower extremity reconstruction, and how the standard of practice has changed over time.

Background and Purpose: Partial thickness rotator cuff tears (PTRCTs) are a common pathology that may significantly impact a spectrum of patients including sedentary individuals, workers, and athletes. Despite their high prevalence, the majority of studies on the treatment of rotator cuff tears have focused on full-thickness tears. PTRCTs have been relatively ignored and subsequently the treatment of PTRCTs remains controversial. The purpose of this review was to evaluate the current state of knowledge regarding PTRCTs including etiology, incidence of site of tear (articular, bursal and interstitial).

Patient and Methods: During the period June 2019 through June 2021, we prospectively studied all patients aged 18–75 years with acute onset of pain after shoulder trauma, with limited active abduction, and with normal conventional radiographs. 171 consecutive patients met these inclusion criteria. The patients had a median age of 51 (18–75) years 65% were males. The patients were divided into 3 groups according to the clinical findings: group I, suspected Rotator Cuff tear (RCT); group II, other specific diagnoses; and group III, sprain. Semi-acute MRI was performed in all patients in group I and in patients in group III who did not recover functionally. Based on MRI findings Incidence on site (articular, bursal, interstitial) of partial thickness rotator cuff tear was found.

Results: We identified 75 patients with PTRCTs. The estimated annual incidence of MRIverified acute PTRCT was 16 (95% CI: 11–23) per 105 inhabitants for the population aged 18–75 years and 25 (CI: 18–36) per 105 inhabitants for the population aged 40–75 years. The prevalence of acute PTRCT in the study group was 75/171 (23%, CI: 18–28). The tears were usually large and affected more than 1 tendon in 36 of these 60 patients. The subscapular is was involved in 38 of the 60 patients.

Interpretation: Acute partial thickness rotator cuff tears are common shoulder injuries especially in men, throwing athletes. They often involve supraspinatus tendon and common site being the articular side.

Electrical burns constitute 3–5% of all burn cases; in developing countries, this ratio increases up to 21–27% 1 and the mortality rate is reported to be between 3.75% and 58.8% 2. Most of the acute burns are life threatening initially requires resuscitation and require various types of surgical interventions such as eschar excision or split-thickness skin grafting, depending on the size, location and depth of the lesion. In this case we will assess the role of bone abrasion of the in the scalp electrical burns involving up to the scalp bone. The Bone abrasion is a procedure that can be utilized in wound bed preparation especially in scalp electrical burns.

Background: Senile osteoporosis is seen in people of age more than 70 years. Senescent bone formation and senile osteoporosis are caused by the differentiation of bone marrow cells into adipocytes, which occurs more frequently than osteoblasts. To identify osteoporosis, a Dual Energy X-ray Absorptiometry (DEXA) scan is employed. T-score and Z-score are used to describe the outcomes. Osteoporosis is defined as a T-score of -2.5 or lower. The bisphosphonate zoledronic acid has demonstrated efficacy in the management of hypercalcemia in multiple myeloma and prostate cancer patients. In the current study, we assess the efficacy of an annual injection of zoledronic acid in treatment of senile osteoporotic patients.

Methodology: The current prospective study was carried out on patients with senile osteoporosis from April 2021 to September 2022 at the Department of Orthopedics, Sri Aurobindo Medical College & Postgraduate Institute, Indore (M.P.). 50 patients with senile osteoporosis 65 years of age and older were enrolled in the study. These individuals were all T-score -2.5 on DEXA scans. After being hydrated with 500ml of intravenous saline solution, these patients received an injection of Zoledronic acid (5mg in 10ml ready to infuse solution). Patients were monitored and assessed for a full year. At each follow-up, the T-score and Z-score were recorded. To determine if the T and Z-scores have improved, the paired "t" test was used. Statistical significance was set at a P value of less than 0.05.

Result: 50 senile osteoporotic patients were included. 52% of them were women and 48% were men. The mean age of the patients was 70.12 ± 5.99 years, ranging from the youngest at 61 to the oldest at 83. In our investigation, we observed diabetes mellitus (36%), hypertension (32%), and asthma (2%). All of the patients had osteoporosis before to receiving the injection, and after 12 months, all of the patients exhibited T-scores indicative of osteopenia. Over the course of a year, there was a noticeable improvement in both the T and Z-scores.

Conclusion: The bone density of patients with senile osteoporosis greatly improved by the once-yearly injection of zoledronic acid. Given that the medication was administered only once a year, patient compliance was likewise very high. For senile osteoporotic patients, we advise using zoledronic acid.