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Background: The study aimed to assess functional and radiological outcomes of the suprapatellar approach (SPA) and infrapatellar approaches (IPA) of tibial nailing in patients with closed tibia shaft fractures. Method: After Institutional Ethical Committee (IEC) and Clinical Trials Registry- India (CTRI) approval, patients with Orthopaedic Trauma Association (OTA) fracture type 42 were enrolled from August 2021 and August 2022 at a level I trauma centre and randomized to SPA and IPA with informed consent. Demographics, American Society of Anaesthesiologists (ASA) physical grading, intraoperative fluoroscopy time, operative duration, bleeding, postoperative radiographic alignment, and union were compared among both approaches. Functional parameters like Lysholm knee score, Anterior knee pain (AKP), Visual Analog Scale (VAS) Score upon kneeling, Knee Injury and Osteoarthritis outcome score (KOOS), KOOS Patellofemoral score (KOOS PF), EuroQol (EQ5D5L), Forgotten joint score (FJS), Range of motion (ROM) of knee and any complications were assessed at 3,6 and 12 months postoperatively. Results: Per protocol analysis of 50 patients (25 SPA, 25 IPA) done at the end of the study. SPA group had significantly lesser fluoroscopy time (91.28 ± 12.40s vs. 105.36 ± 9.23s, p < 0.001) and operative duration (mins) (123.80 ± 24.25 vs. 130.00 ± 18.20, p < 0.001) than IPA. No significant differences were noted in Lysholm knee score at three months (p = 0.094), six months (p = 0.406), and 12 months (p = 0.071). The SPA group showed significantly lower VAS Score upon kneeling at six months (p < 0.0001). Similarly, KOOS (p < 0.001), KOOS PF (p = 0.01), and EQ 5D5L (p = 0.03) were significantly better in the SPA group at six months postoperatively. Lower Coronal translation was found in SPA [0 (0-1.8) vs. 1.4 (0.9-1.8), p = 0.010]. Whereas, IPA had higher range of flexion at 3 months [130.0 (129.0-135.0) vs 123.1 (120.0-130.5), p = 0.047]. However, no significant differences were noted in blood loss, AKP, FJS, EQ-VAS, coronal angulation, sagittal malalignment, time to union, return to work and postoperative complications among the groups. Conclusion: SPA has lesser surgery time, more straightforward anatomic fracture reduction, better fracture alignment, lesser radiation exposure for both patients and surgeons, quicker recovery time, and promotes early kneeling activities with similar long-term functional outcomes and union rates, and can be considered in routine clinical practice than conventional IPA.
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Talar body fracture associated with pan-talar (tibiotalar, talocalcaneal, talonavicular) dislocation is a rare condition. Timely intervention with anatomical reduction will lead to better healing of the fracture. It will result in articular congruity of the talus and less chance of secondary arthritis. We describe a rare talar body fracture with pan-talar dislocation, which does not fit into any of the classifications mentioned in the literature. A young male of 21 years old was admitted to the trauma and emergency department of a tertiary care hospital within three hours of injury. Following the radiological investigations, the patient was found to have a talar body fracture with pan-talar dislocation. Initially, a close reduction was attempted which failed. Subsequently, it was managed with open reduction and internal fixation after eight hours of injury. Talar body fracture was fixed with cannulated cancellous screws and ankle stabilized with joint spanning external fixator. At six months the patient had satisfactory healing of fracture without any irregularity of the articular surface of talus or arthritic changes of involved joints. Early surgical intervention with anatomical reduction of talar body fracture with pan-talar dislocation may lead to better union and less chance of secondary arthritis of peri talar joints.
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High-energy open fractures are often associated with significant soft tissue damage and can have contamination. Infection of a fracture can be the most detrimental factor for fracture union. Control of infection and soft tissue coverage over exposed bone plays a vital role in its overall outcome. Negative pressure wound therapy (NPWT) assisted closure has depicted encouraging results for helping control of infection and wound closure. NPWT assisted closure promotes reduction of bacterial load in the wound, facilitates removal of secretion from the wound, promotes the formation of granulation tissue, and decreases wound size. We present a case of open fracture femur with severe infection and exposed bone. Along with infection and comminution of fracture, there was collection of necrotic tissue at the fracture site. Infection settled with debridement of wound and application of NPWT. With the application of NPWT, there was formation of granulation tissue and a decrease in wound size. The wound healed completely following application of secondary sutures. Any form of plastic procedures, such as muscle pedicle graft and split-thickness skin grafting, was not required for wound closure. NPWT-assisted closure is a promising mode of wound management in grossly infected wounds and obviates the need for further plastic procedures. The effect can be extrapolated to all open wounds with infection but must follow a thorough debridement and lavage.
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Cystic lesion around knee usually presents as painless swelling and diagnosed incidentally by imaging for any internal derangement of the knee. Few cases presented with pain. Intra-tendinous patellar ganglion is very rare in location for the disease. Ganglionic cyst usually treated by aspiration followed by steroid and surgical excision in some cases. We reported a case with anterior knee pain due to patellar intra-tendinous ganglion cyst which treated conservatively with no recurrence even after one year.
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Ipsilateral fracture of the shaft of femur and dislocation of the hip are very rare injuries. There always exists a dilemma regarding the treatment to reduce hip and choosing the appropriate method of ï¬xation for a femur fracture, and a clear consensus is yet to be reached. A number of treatment methods such as the open reduction of femur and ï¬xation followed by hip reduction have been tried so far. Ipsilateral fractures and dislocation occur due to high-energy trauma, and reduction of hip dislocation is considered as an orthopedic emergency. Here, we report a case in which we tried a novel approach by temporarily ï¬xing the femur with an external ï¬xator and reducing the hip dislocation. In the next sitting, we performed femur ï¬xation in a closed manner with an interlocking intramedullary nail. We recommend that this novel method of treatment can be used for such types of injuries.
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Introduction Femoral anteversion is the anterior inclination of the femoral neck and head in relation to the shaft of the femur. Femoral anteversion provides torsional stability of the hip - an important clinical factor for conditions such as trauma, arthroplasty, developmental dysplasia of the hip, and Legg-Calve Perthes disease. Precise measurement is important to avoid instability in pathological conditions of the hip. Computed tomography (CT) measures the angle more accurately as compared to plain radiography and is considered the gold standard procedure for measurement. Patients are exposed to significantly more ionizing radiation in CT, especially the pediatric population, which is more susceptible. Material and methods A prospective study of 25 individuals was undertaken wherein the femoral anteversion angle was comparatively measured by clinical, radiographic, and CT methods. Results The radiological evaluation depicted mean values that were far from those of the CT evaluation as compared to the clinical evaluation. Conclusion The clinical method (trochanter prominence angle test) can be used to measure femoral anteversion to avoid exposure to ionizing radiation and cases where CT is unavailable.
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We report the successful realisation of intrinsic optical polarisation control by growth, in solid-state quantum dots in the thermoelectrically cooled temperature regime (≥200 K), using a non-polar InGaN system. With statistically significant experimental data from cryogenic to high temperatures, we show that the average polarisation degree of such a system remains constant at around 0.90, below 100 K, and decreases very slowly at higher temperatures until reaching 0.77 at 200 K, with an unchanged polarisation axis determined by the material crystallography. A combination of Fermi-Dirac statistics and k·p theory with consideration of quantum dot anisotropy allows us to elucidate the origin of the robust, almost temperature-insensitive polarisation properties of this system from a fundamental perspective, producing results in very good agreement with the experimental findings. This work demonstrates that optical polarisation control can be achieved in solid-state quantum dots at thermoelectrically cooled temperatures, thereby opening the possibility of polarisation-based quantum dot applications in on-chip conditions.