Journal of Orthopedic Education

Introduction: The most commonest long bone to be fractured in an acute traumatic setting is tibia followed by femur. Due to low soft tissue coverage over the bone, they have a higher propensity to end up in open fractures. The fracture variety is described based on location as well as on the type of shearing injury. Due to the delicate inherent vascularity to the tibia bone, in an acute setting with high shearing mechanism, there is a higher chance for the primary fixation to fail due to the fractured ends going into non-union or mal-union. We report a case of a middle aged man, who met with a road traffic accident (RTA) and had presented to the casualty with an open injury and deformity of the left leg. Case presentation: A comprehensive history and clinical examination revealed a lacerated wound on the lateral aspect of the distal third of the left leg, accompanied by swelling and visible deformity, though vital signs remained stable. Radiographs confirmed fractures of the distal third of tibia and fibula. Initial treatment involved wound debridement with application of an AO external fixator, but due to the extent of contamination it led to a bone infection that required resection, resulting in a 55-millimeter segmental bone loss. Following careful pre-operative planning, a four-ring Ilizarov external fixator (IEF) was applied, along with a proximal corticotomy and the accordion manoeuvre. The patient was monitored with serial radiographs for nearly 30 months, during which a 71-millimeter bone regenerate was achieved. The external fixator was then removed, and the patient was fitted with a knee-ankle-foot orthosis (KAFO) for four weeks, along with supportive physiotherapy. Post-surgery, the patient is now able to fully bear weight, has achieved 90° knee flexion, experiences limited ankle movement, and has a 3-centimeter limb length discrepancy. Conclusion: Open tibia fractures are in itself a challenge to treat and if primary reduction fails, the main mode of management would include limb salvage procedures of which IEF application holds the torch to all other techniques. Removal of the infected bone segment and application of four ring IEF construct gave satisfactory results in regaining the bone regenerate

Acromioclavicular Joint injury, is a traumatic injury to the Acromio Clavicular (AC) joint with disruption of  acromioclavicular and coracoclavicular ligaments. Bilateral focused shoulder radiographs are used for diagnosing this injury. Treatment is immobilization or surgical reconstruction depending on patient activity levels, degree of separation and degree of ligament injury. Here, we are publishing one such case report of reconstruction of the Acromioclavicular joint.
 

Stimulan Rapid Case Solution Sulfate Powder with aqueous mixing solution after mixing, the paste implanted into open infected fractures, it will help in controlling infection and dead space management. It is only calcium matrix approved for use in bone and soft tissue. Masquelet technique is a two staged procedure, at first operation radical soft tissue and bone debridement is undertaken. A polymethyl methacrylate (PMMA) Cement spacer is implanted at the site of the bone defect and limb is stabilized with external fixator, series of patients of compound fractures (Bone void) and infection were managed & reported.
 

Simultaneous existence of ENT disorders with orthopaedic conditions stands to be a tremendous challenge in diagnosis and management especially among the elderly. Generally, such conditions often exhibit similar symptoms of dizziness, pain, and moving difficulty associated with both conditions in a patient. The article presents complexities in treatment of ENT patients, in which orthopaedic disorders bring solutions concerning diagnostic ambiguity, treatment interactions, surgical risks, and age-related comorbidities. Such conditions can best be treated through a multi-disciplinary approach, wherein the ENT specialists and orthopaedic surgeons are involved. Advanced diagnostic tools such as MRI and CT scans would be necessary in each case to distinguish between overlapping symptoms, while coordinated treatment plans help mitigate the potential drug interactions. Overcoming the challenges of surgery remains based on the preoperative planning and rehabilitation plans that are tailored to each patient; it is important that geriatric assessment tools be used well to control the increased risks associated with elderly patients. Such education and communication with the patient are an effective strategy for adherence and implementation of treatment plans, which may improve outcomes. More research studies on treatment protocols need to be done for integrated care to be able to contribute to proactive patient engagement and strengthen treatment for complex comorbidity patients.
 

Conservative treatment of spine disease with acupuncture involves using acupuncture to stimulate healing, reduce pain, and improve function. Presently, No method or treatment is considered ideal for handling spine problems. Acupuncture is scientific, effective, and without any side effects. Moreover, Acupuncture treatment can be continued with other therapies without any interaction. Several studies based on systematic reviews show a short-term clinically relevant reduction of pain in Chronic Lower back pain. World Health Organization anticipated that spinal problems would be common in elderly people. Hence,these acupuncture treatments can provide the best results with other ongoing Western medicines. Studies also suggested that post-operative care could give the best and quickest outcomes if acupuncture treatments were administered with Western treatment. Huge clinical trials with long-term follow-ups need to be declared to the level of choice of treatment.
 

Hamate fractures, although rare, present significant diagnostic and management challenges, particularly when involving the hook of the hamate, commonly seen in athletes and labourers. This narrative review explores the epidemiology, clinical presentation, imaging modalities, and treatment strategies for hamate fractures. Despite accounting for only 2-4% of all carpal fractures, delayed or missed diagnoses can lead to complications such as non-union, ulnar nerve compression, and chronic pain. Clinical examination, including specific manoeuvers like the pull test, can aid in early detection, while computed tomography (CT) is the gold standard for accurate diagnosis. Non-operative treatment, including immobilization, is reserved for stable, non-displaced fractures, while displaced fractures, fractures of the hamate body, or those with complications such as non-union often require surgical intervention. Hook excision and open reduction with internal fixation (ORIF) are the most commonly performed surgical procedures. Rehabilitation plays a crucial role in functional recovery, with early mobilization recommended once the fracture heals. With advancements in diagnostic and surgical techniques, outcomes following hamate fractures are generally favourable, allowing patients to return to daily activities and athletic pursuits with minimal long-term sequelae. Further research into tailored treatment protocols and rehabilitation strategies could further enhance patient outcomes.
 

The large soft tissue defect in the lower leg and its treatment remain a challenge. The most suitably available type of tissue, the surgery timing, and the decision between free flap or local for the coverage still remain the subject of debate. One hundred and four patients were managed with a free flap or local cover for a lower leg soft-tissue defect. We compared the outcomes after treatment with free flaps versus local and musculocutaneous flaps versus  fasciocutaneous flaps. In this study, we also compared the results of our patients according to the timing of the surgery: patients managed within 3 days after the trauma versus patients managed after 3 days. Thirty-four patients (32.69%) were presented with chronic osteomyelitis and treated accordingly. Seventy patients (67.30%) with posttraumatic soft-tissue defects have been treated because of insufficient fracture coverage. The statistically significant difference in complications was not observed in free and local flaps in our study. Postoperatively. In our study group, patients managed with a musculocutaneous flap were associated with less postoperative complications than fasciocutaneous. In the number of revisions after treatment with a free flap, a significant increase could be demonstrated in the results after early or late flap coverage. There was no significant difference observed. Equal outcomes were observed in patients treated with free flaps or local flaps except local flaps, which required a lesser number of revisions postoperatively. Regarding postoperative complications, Musculocutaneous flaps are preferable over fasciocutaneous flaps. The operation timing is not to be proved a discriminating factor.