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Proximal femoral nailing is the gold standard of surgical treatment for unstable intertrochanteric hip fractures. One of the intraoperative complications encountered in this procedure is the nail-jig mismatch due to causes such as manufacturing errors and fatigue deformation of sleeves or jig. Nail-jig mismatch leads to eccentric placement of guidewire within the screw slots of PFN and subsequent difficulty in reaming and screw insertion. The potential complications of this include guide wire deformation, breakage, nail damage and screw malposition. We propose a simple and effective technique to tackle this complication, called as "Screw first" technique. The principle of this technique is to utilize screws as guide wire sleeves to effectively centralize the guidewire position within nail slots. On identifying a mismatch by the eccentric position of guidewire, a long screw is first inserted partially till its shaft engages into the screw slot allowing subsequent insertion of a guidewire which assumes a centralized position, thus bypassing the mismatch of jig. Following this, the usual steps of reaming and final screw insertion are undertaken. This method is effective, simple, quick and requires no special instrumentation.

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A femur fracture is one of the most commonly encountered fractures by orthopaedicians worldwide. Being one of the longest and strongest bones in the body, it is one of the principal load-bearing bones of the lower extremity. Various modalities of fixation have been tried and tested for femur fracture but the most accepted fixation modality for diaphyseal femur fracture worldwide is the interlocking intramedullary nailing. However, intramedullary nailing is not free of any complications. Complications such as infection, non-union, malunion, limb length discrepancy due to wrong size nail, screw or nail breakage, and injury to neurovascular structures while passing guidewire or drilling for the interlocking bolt are commonly reported. We report a case of a patient who presented with a neglected broken femoral nail which resulted in an urethrocutaneous fistula. As per our literature review, this complication has never been reported before.

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AIM: The objective of the study is to compare the accuracy of implant positioning and limb alignment achieved in robotic-arm assisted total knee arthroplasty(RATKA) and manual total knee arthroplasty(MTKA) to their respective preoperative plan. PATIENTS AND METHODS: This was a prospective observational study conducted in a tertiary care centre between August 2018 and January 2020. 143 consecutive RATKA(105 patients) and 151 consecutive MTKA(111 patients) performed by two experienced arthroplasty surgeons were included. Two independent observers evaluated the accuracy of implant positioning by measuring the radiological parameters according to the Knee-Society-Roentgenographic-Evaluation-System and limb alignment from postoperative weight-bearing scanogram. Outcomes were defined, based on the degree of deviation of measurements from the planned position and alignment, as excellent(0-1.99°), acceptable(2.00-2.99°) and outlier(≥ 3.00°). RESULTS: There were no systematic differences in the demographic and baseline characteristics between RATKA and MTKA. Statistically significant outcomes were observed favouring robotic group for postoperative mechanical axis (p < .001), coronal inclination of the femoral component (p < 0.001), coronal inclination of tibial component (p < 0.001), and sagittal inclination of tibial component (p < 0.001). There was no significant difference in the sagittal inclination of the femoral component (p = 0.566). The percentage of knees in the 'excellent' group were higher in RATKA compared to MTKA. There was absolutely no outlier in terms of limb alignment in the RATKA group versus 23.8% (p < 0.001) in the MTKA group. All the measurements showed high interobserver and intraobserver reliability. CONCLUSION: Robotic-arm assisted TKA executed the preoperative plan more accurately with respect to limb alignment and implant positioning compared to manual TKA, even when the surgeons were more experienced in the latter. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s43465-020-00324-y.

RESUMEN

BACKGROUND: Purpose was to correlate flexor pollicis longus tendon (FPL) attrition using Ultrasonography with plate position on radiographs following volar locked compression plate fixation (LCP) in patients who have undergone pronator quadratus (PQ) repair for distal radius fractures. METHODS: Status of flexor pollicis longus tendon was analyzed by ultrasonography in patients who underwent volar locked compression plating with pronator quadratus repair at a minimum of one year follow up. Soong's criteria was used to assess the plate position and then correlated the ultrasonography findings of flexor pollicis longus. RESULTS: There were 33 patients included in our study, of which 15 belonged to Soong's grade zero, 10 were grade one and eight were grade two. Flexor pollicis longus attrition was noted in all cases with grade two plating. CONCLUSION: Pronator quadratus repair may not prevent attritional changes in higher grades of Soong's, hence follow up may be required in these patients to identify attritional changes and early implant removal to prevent complications.

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BACKGROUND: Our study aims to determine the planned accuracy of the tibial component placement in robotic arm assisted unicompartmental knee arthroplasty (UKA) versus the conventional jig based UKA of the initial cases done in India for the first time with this particular robotic system.Materials & Methods: Study group 1 consisted of patients who underwent robotic arm (MAKO, Stryker, USA) assisted UKA. Group 2 consists of patients who underwent a standard conventional jig based (Oxford knee, Biomet, UK). Post-operative radiographs were taken to determine the Tibial Implant position and orientation which were compared to their preoperative plan respectively by two independent observers. The mean error value was obtained for both study groups respectively and compared to determine the accuracy of the post-operative tibial implant placement. RESULTS: In the Robotic arm assisted UKA, the deviation of post-operative varus angle from preoperative planned angle was about 0.43° and post-operative Tibial slope alignment differed from preoperative plan was 0.41°. In the Conventional UKA group post-operative varus angle differed from preoperative planned angle by about 2.12° and post-operative Tibial slope alignment deviation from preoperative plan was 2.47°. CONCLUSIONS: Robotic arm assisted system was more accurate compared to the conventional jig-based technique in achieving the planned orientation and alignment of the tibial implant in the initial learning phase of this particular Robotic System used for the first time in India. MESH TERMS: partial knee replacement, robotic assisted surgery.

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BACKGROUND: Haemophilia is characterized by a partial or complete deficiency of clotting factor VIII or IX. The repeated bleeding episodes into the joints contributes to subsequent chronic arthropathy which debilitates the patient and affects the quality of life. There are lot of hurdles in successful management of such patients. We present our experience in dealing such patients. MATERIALS AND METHODS: 24 patients (27 knees) with haemophilic knee arthropathy were included. The preoperative VAS (Visual Analogue Scale) and KSS (Knee Society Score) were assessed. All underwent total knee arthroplasty with stemmed constrained prosthesis. Postoperatively VAS and KSS were analysed at the end of 12 months. RESULTS: The mean preoperative VAS was 8.2 (Range: 7-10), mean KSS clinical score was 39.9 (Range: 12-61) and mean KSS functional score was 51.4(Range: 20-70). The mean postoperative VAS was 2.7(Range: 2-4), mean KSS clinical score was 70.5 (Range: 61-80) and mean KSS functional score was 74.2(Range: 60-80). There was statistical significant difference between preoperative and post-operative scores. At the end of 12 months, 17 patients (63%) had good outcome, seven patients (26%) had fair and three patients (11%) had excellent outcome as per the KSS scores. CONCLUSIONS: Total knee arthroplasty has good outcome with respect to clinical as well as functional outcome in haemophilic arthropathy. Although the results and outcome of total knee arthroplasty in haemophilic knee arthropathy may still be inferior to the results seen in a normal individual, a multidisciplinary approach yields a better functional and quality of living in such haemophilic patients.

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Carpometacarpal (CMC) joint dislocation other than thumb are rare injuries and can be easily missed. These injuries account for <1% of all hand injuries and are frequently overlooked or missed. CMC dislocations can occur either in dorsal or volar direction and be associated with fractures. However, dorsal dislocation is more commonly encountered than volar dislocation. Volar CMC joint dislocations are rare and need a high level of suspicion for diagnosing and prevention of complications. We present a 36-year-old woman with post-traumatic neglected volar dislocation of all the five CMC joints leading to a windswept deformity of the hand.

Asunto(s)

Articulaciones Carpometacarpianas/diagnóstico por imagen , Fijación Interna de Fracturas , Deformidades de la Mano/diagnóstico por imagen , Traumatismos de la Mano/diagnóstico por imagen , Luxaciones Articulares/diagnóstico por imagen , Accidentes de Tránsito , Adulto , Hilos Ortopédicos , Articulaciones Carpometacarpianas/fisiopatología , Articulaciones Carpometacarpianas/cirugía , Moldes Quirúrgicos , Diagnóstico Tardío , Femenino , Deformidades de la Mano/cirugía , Traumatismos de la Mano/fisiopatología , Traumatismos de la Mano/cirugía , Humanos , Luxaciones Articulares/fisiopatología , Luxaciones Articulares/cirugía , Radiografía , Resultado del Tratamiento

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Since antiquity, Piper betel. Linn, commonly known as betel vine, has been used as a religious, recreational and medicinal plant in Southeast Asia. The leaves, which are the most commonly used plant part, are pungent with aromatic flavor and are widely consumed as a mouth freshener. It is carminative, stimulant, astringent and is effective against parasitic worms. Experimental studies have shown that it possess diverse biological and pharmacological effects, which includes antibacterial, antifungal, larvicidal, antiprotozal, anticaries, gastroprotective effects, free radical scavenging, antioxidant, anti-inflammatory hepatoprotective, immunomodulatory, antiulcer and chemopreventive activities. The active principles hydroxychavicol, allylpyrocatechol and eugenol with their plethora of pharmacological properties may also have the potential to develop as bioactive lead molecule. In this review, an attempt is made to summarize the religious, traditional uses, phytochemical composition and experimentally validated pharmacological properties of Piper betel. Emphasis is also placed on aspects warranting detail studies for it to be of pharmaceutical/clinical use to humans.