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Purpose: To identify posterior cruciate ligament (PCL) peel-off lesions, to separate these lesions from more common midsubstance tears, and to evaluate patient outcomes after primary open repair. Methods: Patients with acute femoral-side "peel off"-type lesions associated with multiligamentous injuries who underwent PCL repair were identified. Patients with chronic PCL injuries, midsubstance PCL tears, or PCL tibial avulsions were excluded from the study. A total of 11 patients were included in this study. All patients underwent open repair using a suture pullout technique. Results: The mean follow-up period was 18 months. The mean Lysholm score at 12 months was 87. Mean knee range of motion (flexion) achieved at 12 months was 121°. No patient had grade 3 laxity on posterior stress testing at final follow-up. Conclusions: Our study showed good outcomes after primary repair of femoral PCL peel-off lesions. Level of Evidence: Level IV, therapeutic case series.
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Tuberculous osteomyelitis affecting long bones is a rare form of tuberculosis. Among infants born in endemic region, often it is difficult to diagnose owing to its subtle clinical features. Here, a case of tuberculous osteomyelitis affecting the distal radial metaphysis is reported, presenting as a cystic lesion in a nine-month-old male infant. Open biopsy with curettage was performed followed by filling of the cavity with synthetic bone substitute (beta tricalcium phosphate granules). The diagnosis was confirmed by histopathological examination and demonstration of acid fast bacilli. Further treatment with anti-tubercular drugs led to clinical and radiological improvement. This case report highlights the importance of keeping tuberculosis as a differential diagnosis while dealing with cases with similar presentation in an endemic region.
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BACKGROUND: With changing trends in treatment of displaced midshaft clavicle fractures (DMCF), plating remains the standard procedure for fixation. An attracting alternative method of fixation is the titanium elastic nailing (TEN). However, prospective randomized studies comparing the two methods of fixation are lacking. We assessed the effectiveness of minimally invasive antegrade TEN and plating technique for the treatment of DMCF. MATERIALS AND METHODS: 80 unilateral displaced midclavicular fractures operated between October 2010 and May 2013 were included in study. This prospective comparative study was approved by the local ethical committee. Followups were at 2(nd) and 6(th) weeks and subsequently at 3, 6, 12, 18 and 24 months postoperatively. Primary outcome was measured by the Constant score, union rate and difference in clavicular length after fracture union. Secondary outcome was measured by operative time, intraoperative blood loss, wound size, cosmetic results and complications. RESULTS: During analysis, we had 37 patients in the plate group and 34 patients in the TEN group. There was no significant difference in Constant scores between the two groups. However, faster fracture union, lesser operative time, lesser blood loss, easier implant removal and fewer complications were noted in the TEN group. CONCLUSION: The use of minimally invasive antegrade TEN for fixation of displaced midshaft clavicle fractures is recommended in view of faster fracture union, lesser morbidity, better cosmetic results, easier implant removal and fewer complications; although for comminuted fractures plating remains the procedure of choice.
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Modified Boytchev is one of good operative procedure for recurrent anterior dislocation of shoulder in terms of recurrence and loss of motion of shoulder by rerouting the conjoined tendon deep to subscapularis. To know the possible mechanism of this procedure, electromyographic study showed the significantly greater recruitment pattern in subscapularis as compared to pre-operative subscapularis electromyographic pattern and other rotator cuff muscles.
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Electromiografía , Manguito de los Rotadores/fisiología , Luxación del Hombro/cirugía , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Reclutamiento Neurofisiológico/fisiología , Recurrencia , Adulto JovenRESUMEN
The present study was being undertaken in retrospective and prospective basis to investigate the ultimate outcome of the procedure in type IIIA and type IIIB injuries. We have used simple AO type of external fixator and applied uniplanar double tube frame and unilateral biplanar frame. Frames were selected randomly; unilateral uniplanar frame in some patients having type IIIA wound and in some patients having type IIIB wound. Similarly, unilateral biplanar frames were used in some patients with observations have shown that these external fixators are simple, easy to apply, cost-effective and yield acceptably good results. Thus, the 'external fixator' application for the management of open fractures of tibia may give good results even to the poor patients and may be suitable for underdeveloped and developing countries. A study was undertaken by the committee on fracture and traumatic surgery of the American Academy of Orthopedic Surgeons to evaluate the efficacy and practicability of this method of treatment. The study was carried out in the department of orthopaedics, RG Kar Medical College & Hospital, Kolkata in retrospective and prospective basis since June, 2005. Forty-seven patients were selected from the outpatients department and emergency department having open fracture of shaft of the tibia with or without fracture of the fibula and were treated in the orthopaedic indoor department. The patients were followed up for 6 months to 2 years. Out of 47 cases, 2 patients could not be communicated for follow-up. Normal union could be seen in 25 patients followed by delayed union (n = 11) and malunion (n = 11). Joint shiffness was seen in 16 patients.
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Fijadores Externos , Fracturas Abiertas/cirugía , Fracturas de la Tibia/cirugía , Adolescente , Adulto , Femenino , Curación de Fractura , Fracturas Mal Unidas/etiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE: Despite new developments in the management of osteoporotic fractures, complications like screw cutout are still found in the fixation of proximal femur fractures even with biomechanically proven better implants like proximal femoral nail antirotation (PFNA). The purpose of this cadaveric study was to investigate the biomechanical stability of this device in relation to two common positions (center-center and inferior-center) of the helical blade in the femoral head in unstable trochanteric fractures. MATERIALS AND METHODS: Eight pairs of human cadaveric femurs were used; in one group [center-center (C-C) group], the helical blade of PFNA was fixed randomly in central position both in anteroposterior and lateral view, whereas in the other group it was fixed in inferior one-third position in anteroposterior and in central position in lateral view [inferior-center (I-C) group]. Unstable intertrochanteric fracture was created and each specimen was loaded cyclically till load to failure RESULTS: Angular and rotational displacements were significantly higher within the C-C group compared to the I-C group in both unloaded and loaded condition. Loading to failure was higher in the I-C group compared to the C-C group. No statistical significance was found for this parameter. Correlations between tip apex distance, cyclic loading which lead to femoral head displacement, and ultimate load to failure showed a significant positive relationship. CONCLUSION: The I-C group was superior to the C-C group and provided better biomechanical stability for angular and rotational displacement. This study would be a stimulus for further experimental studies with larger number specimens and complex loading protocols at multicentres.
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BACKGROUND: More than 200 different operations have been described for the treatment of recurrent anterior dislocation of shoulder. The Modified Boytchev procedure employs rerouting of the detached tip of coracoid process with its attached conjoined tendon (short head of biceps and coracobrachialis) deep to subscapularis and reattaches to its anatomical location. We conducted a study on evaluation of long-term effect of modified Boytchev procedure and to compare our results with other studies published in literature. MATERIALS AND METHODS: Since June 2002, modified Boytchev procedure was performed on 48 patients, who presented with recurrent anterior dislocation. 45 were men and 3 were women and were in the age group of 18-40 years (mean 27.83±4.95 years). Forty patients were affected on the dominant side and rest on the non-dominant side. The mean number of dislocations in these patients was 18.22±12.08. The mean followup period was 58.13±19.06 months (range 18-96 months). The patients were evaluated by visual analogue score, modified American Shoulder and Elbow Surgeon's Score (ASES), and Single Assessment Numeric Evaluation (SANE) score at the last followup. RESULTS: All the patients regained almost preoperative range of forward flexion at the last followup. In the preoperative period the mean external rotation deficit at 0° and at 90° of abduction was 13.22°±5.16° and 18.06°±6.50°, respectively. At the last followup, the mean external rotation deficit at 0° and at 90° of abduction was 8.06°±2.47° and 8.95°±2.07°, respectively. This improvement in external rotation deficit was statistically significant (P<.05). Preoperative scores were compared with the most recent followup scores for all variables with use of a paired t test. All patients had significant improvement in visual analogue score, modified American Shoulder and Elbow Surgeon's Score (ASES), and Single Assessment Numeric Evaluation (SANE) score at the last followup. Four of the patients developed superficial infection which got resolved after treating with antibiotics, and two of the patients developed transient musculocutaneous nerve paresis. There was no radiological evidence of loosening and migration of coracoid screw or any glenohumeral arthritis on subsequent followup of skiagrams in any of our patients. CONCLUSION: Modified Boytchev procedure is an efficacious and technically simple procedure to treat recurrent anterior dislocation of shoulder.
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Twenty-five patients with dorsolumbar spinal injury was treated by pedicular screw fixation along with direct or indirect decompression within 1 1/2 years period. Eighteen patients with incomplete neurodeficit had some amount of neurological recovery in terms of ASIA impairment scale but no neurological recovery was seen in 6 patients with complete neurological injury. Mean correction of kyphotic angle was 11.76 degrees. Mean postoperative increase in anterior vertebral body height was 43%. Complications like bed sore, superficial wound infections and peroperative dural tear were seen but all of which were treated successfully. Neurological deterioration after operation, screw pull out and implant failure were seen in none. This study indicates that short segment pedicular screw fixation is a safe and effective method for treatment of unstable spinal injury.
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Tornillos Óseos , Fijación de Fractura , Cifosis/cirugía , Vértebras Lumbares/cirugía , Traumatismos Vertebrales/cirugía , Adolescente , Adulto , Femenino , Fijación de Fractura/efectos adversos , Fijación de Fractura/instrumentación , Fijación de Fractura/métodos , Humanos , Cifosis/diagnóstico , Cifosis/etiología , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Examen Neurológico/métodos , Complicaciones Posoperatorias/terapia , Radiografía , Traumatismos Vertebrales/complicaciones , Traumatismos Vertebrales/diagnóstico , Índices de Gravedad del Trauma , Resultado del TratamientoRESUMEN
Displaced midclavicular fractures resulting in malunion with shortening and rotational deformity does not remodel in adults and incidence of non-union in displaced midshaft clavicular fractures is between 10-15% especially in those with an initial shortening of >20 mm.We have treated 10 patients of displaced middle-third clavicle fracture by open reduction and internal fixation with plate and screws and found it to be very effective in respect to rehabilitation, union and cosmesis.
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Clavícula , Fijación Interna de Fracturas , Fracturas Mal Unidas/cirugía , Fracturas no Consolidadas , Complicaciones Posoperatorias , Adulto , Placas Óseas , Tornillos Óseos , Clavícula/lesiones , Clavícula/fisiopatología , Clavícula/cirugía , Femenino , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Fracturas Mal Unidas/fisiopatología , Fracturas no Consolidadas/etiología , Fracturas no Consolidadas/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Recuperación de la Función , Índices de Gravedad del Trauma , Resultado del TratamientoRESUMEN
Operative treatment modalities for calcaneal fracture are still controversial. The outcome of intra-articular calcaneal fracture is mainly influenced by the soft tissue and the subtalar joint. Percutaneous method of internal fixation has been attempted to avoid the problems. Patients with displaced intra-articular calcaneal fracture types IIA, IIB and IIC were treated by initial distraction of subtalar joint, restoration the of subtalar joint, reduction of lateral expansion and finally fixation with screws percutaneously. Twenty-two patients with 26 calcaneal fractures were included. After a mean follow-up of 2 1/2 years and with American Orthopaedic Foot and Ankle Society hind foot score 82 points out of 100. Percutaneous fixation of calcaneum fracture is good alternative method in types IIA, IIB and IIC and selective type III fractures.
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Tornillos Óseos , Calcáneo/cirugía , Fijación Interna de Fracturas , Fracturas Mal Unidas/cirugía , Fracturas Intraarticulares/cirugía , Articulación Talocalcánea/cirugía , Adulto , Calcáneo/diagnóstico por imagen , Calcáneo/lesiones , Calcáneo/fisiopatología , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Fracturas Mal Unidas/diagnóstico por imagen , Fracturas Mal Unidas/fisiopatología , Humanos , Fracturas Intraarticulares/diagnóstico por imagen , Fracturas Intraarticulares/fisiopatología , Masculino , Persona de Mediana Edad , Cuidados Posoperatorios/métodos , Radiografía , Recuperación de la Función , Articulación Talocalcánea/diagnóstico por imagen , Articulación Talocalcánea/lesiones , Articulación Talocalcánea/fisiopatología , Índices de Gravedad del Trauma , Resultado del TratamientoRESUMEN
Sixty-two femoral shaft fractures in 60 patients treated by elastic intramedullary nailing with mean age of the patients being 9.2 years (range 5 years to 12 years) and average follow-up of 15 months (range 7 months to 60 months) are evaluated. Twenty-eight fractures were fixed with titanium elastic nail while 34 fractures were fixed with Enders nail. There were 40 midshaft fractures, 18 proximal femoral and 4 were fractures of distal third. Fracture patterns were transverse in 35, short oblique in 14 cases and 13 were spiral fractures. Mean age of union in this series was 17 weeks (range 12 weeks to 28 weeks). Ten cases had complications, 5 had nail tip irritation, 3 varus or valgus malalignment and 2 had delayed union. In this series, we did not have any non-union, refracture, limb length discrepancy or any major infection. The result demonstrates 100% union rate irrespective of the age, weight and height of the patient. Regardless of the site of fracture and their pattern, it united every time with elastic nail fixation. We did not find and mismatch in the results of fractures stabilised with titanium elastic nail with that of elastic stainless steel nail.