Intramedullary Kirschner Wire Fixation for Metatarsal Fractures: A Comprehensive Review of Treatment Outcomes.

Metatarsal fractures pose significant challenges in orthopedic practice, necessitating effective treatment methods to ensure optimal patient outcomes. This comprehensive review focuses on intramedullary Kirschner wire fixation as a promising intervention for metatarsal fractures. Beginning with an overview of metatarsal fractures and the imperative for effective treatments, the review delves into intramedullary fixation's definition, historical background, advantages, and disadvantages. Indications for its use in metatarsal fractures are discussed, providing a foundation for understanding its application. The surgical technique section outlines critical aspects, including patient selection criteria and preoperative planning. Before presenting a detailed step-by-step procedure for intramedullary Kirschner wire fixation, anesthesia considerations are explored. Emphasizing precision, fluoroscopic guidance, and meticulous postoperative care, this section provides insights for surgeons and healthcare practitioners. Considerations for rehabilitation follow, addressing postoperative care, expected recovery timelines, and physical therapy recommendations. Early mobilization, weight-bearing guidelines, and a structured rehabilitation program play pivotal roles in recovery. In the conclusion, key findings are summarized, highlighting the efficacy of intramedullary Kirschner wire fixation, its advantages, and recommendations for clinical practice. Additionally, areas for future research are identified, guiding further exploration and refinement of this surgical approach. This review is valuable for clinicians, researchers, and healthcare practitioners involved in metatarsal fracture management, contributing to the evolution of treatment strategies and improving patient care.

Subcutaneous Angiofibroma of the Ankle: A Rare, Undescribed Clinical Entity.

Soft tissue angiofibroma is a pathology consisting of a benign fibrous vascularized tumor that mimics low-grade sarcoma. Such tumors frequently arise in the extremities, more commonly in the lower extremities, presenting as a slow-growing, painless swelling. Females are more commonly affected than males. We present the case of a 42-year-old male with a slow-growing, painless mass on the extensor aspect of his left foot. Differential diagnoses considered were soft tissue fibrosarcoma, liposarcoma, and sebaceous cysts. Surgical excision of the tumor was done, and upon histopathology, there were multiple lobules with well-circumscribed, alternating areas of collagenous and myxoid tissues. There was a prominent small vascular network with uniformly arranged spindle cells consisting of pale eosinophil-rich cytoplasm and small ovoid nuclei, fine chromatin, and an indistinct nucleolus. There are not many reported cases of this clinical entity, and every new case reported brings light to the pathology and progression of this tumor. Understanding this pathology is necessary since it mimics many other skin and soft tissue tumors.

Synovial Chondromatosis in a Young Athlete: A Report of a Rare Case.

Synovial chondromatosis is a rare and benign disorder that involves the synovial lining of joints, synovial sheaths and bursae. The synovial layer of the joint is affected by a metaplastic process which in turn converts it into cartilagenous tissue. Eventually, it gets dislodged and transformed into a loose body in the large joints. We report the case of a 24-year-old young athlete who presented with complaints of painful movements and restriction of joint movements associated with a growing deformity in the right knee joint. This case report aims to describe a rare synovial pathology that necessitated arthroscopic synovectomy and diagnostic arthroscopy to treat, particularly in younger individuals. The atypical feature, in this case, was metaplastic development from the peripheral joint capsule attached to the surrounding cartilage, which, to the extent that the authors are aware, has only been documented in one instance in the record. Magnetic resonance imaging (MRI) was performed which demonstrated evidence of the joint effusion, synovial hypertrophy and a loose calcific body just anterior of the distal femoral condyle causing pressure over the patellar tendon anteriorly as well as a hyper-dense cyst in the popliteal region. Treatment often requires partial or complete synovectomy with either an arthroscopic or open approach.

The Impact of Tranexamic Acid on Blood Loss Management in Primary Total Knee Arthroplasty: A Comprehensive Review.

Total knee arthroplasty (TKA) is a widely performed surgical procedure to restore function and relieve pain in patients with advanced knee arthritis. One of the key challenges in TKA is managing perioperative blood loss, which can lead to complications such as postoperative anemia and the need for blood transfusions. Tranexamic acid (TXA), an antifibrinolytic agent, has shown promising results in reducing blood loss and transfusion requirements in various surgical settings, including TKA. This comprehensive review synthesizes current evidence regarding the efficacy and safety profile of TXA in primary TKA. Mechanistically, TXA functions by inhibiting the breakdown of fibrin clots, promoting hemostasis, and minimizing blood loss. Clinical studies evaluating TXA in TKA have consistently demonstrated significant reductions in blood loss parameters, including total blood loss, postoperative drain output, and transfusion rates. Key findings highlight the efficacy of TXA across different dosing regimens and administration routes, with minimal associated risks of thromboembolic events or adverse effects. Comparative analyses with other blood conservation strategies underscore TXA's superiority in reducing transfusion requirements and its cost-effectiveness in clinical practice. The review also discusses current clinical guidelines and recommendations for TXA use in TKA, emphasizing optimal dosing strategies and patient selection criteria. Future research directions include exploring the long-term outcomes of TXA administration and its impact on functional recovery, and refining protocols to enhance its efficacy and safety further. In conclusion, TXA represents a valuable adjunct in blood loss management during primary TKA, offering substantial benefits in patient outcomes, healthcare resource utilization, and cost-effectiveness. Continued research efforts are warranted to optimize its use and expand its applicability in orthopedic surgery.

A Comprehensive Review of Genetic Variations in Collagen-Encoding Genes and Their Implications in Intervertebral Disc Degeneration.

This comprehensive review examines the intricate relationship between genetic variations in collagen-encoding genes and their implications in intervertebral disc degeneration (IVDD). Intervertebral disc degeneration is a prevalent spinal condition characterized by structural and functional changes in intervertebral discs (IVDs), and understanding its genetic underpinnings is crucial for advancing diagnostic and therapeutic strategies. The review begins by exploring the background and importance of collagen in IVDs, emphasizing its role in providing structural integrity. It then delves into the significance of genetic variations within collagen-encoding genes, categorizing and discussing their potential impact on disc health. The methods employed in studying these variations, such as genome-wide association studies (GWASs) and next-generation sequencing (NGS), are also reviewed. The subsequent sections analyze existing literature to establish associations between genetic variations and IVDD, unraveling molecular mechanisms linking genetic factors to disc degeneration. The review concludes with a summary of key findings, implications for future research and clinical practice, and a reflection on the importance of understanding genetic variations in collagen-encoding genes to diagnose and treat IVDD. The insights gleaned from this review contribute to our understanding of IVDD and hold promise for the development of personalized interventions based on individual genetic profiles.

Management of Vancouver B3 Periprosthetic Femur Fracture Using a Modular Uncemented Long Femoral Stem Prosthesis With Cerclage Wiring Technique.

Periprosthetic fractures (PPF) of the femur in connection with total hip arthroplasty are becoming common and also frequently challenging to repair. Such patients typically are frail, elderly, and have osteoporosis. Owing to a scarcity of research there are no clear strategies for its effective management. However, the Vancouver classification may help in facilitating treatment decisions. For fractures around a loose femoral prosthesis (types B2 and B3), revision using a modular uncemented long stem, with or without additional fracture fixation, has been known to provide a reliable outcome. It is prudent to treat osteoporosis for fracture healing and to prevent further fractures. In this case report, we share our experience with the use of an uncemented modular long femoral stem prosthesis with a cerclage wiring technique for the management of Vancouver type B3 PPF of the left femur in a 63-year-old male patient. Revision arthroplasty using a long stem prosthesis with a cerclage wiring technique can provide better fixation, stability, and functional outcomes for the patient.

Pott's Spine Unveiled: A Comprehensive Case Report and Surgical Intervention.

This case report describes the presentation, diagnosis, and surgical management of a 61-year-old female admitted to a tertiary care hospital with a two-month history of neck pain and weakness in all four limbs. Despite the absence of a clear history of trauma, a detailed examination revealed restricted neck flexion, paraspinal muscle spasm, and neurological deficits. Contrast-enhanced MRI indicated vertebral osteomyelitis and discitis at the C5-C6 level, with a suspected infective etiology, possibly tuberculosis spondylitis. The patient underwent anterior cervical decompression, corpectomy of C5-C6, and fusion of C4-C7. Postoperative management included intravenous antibiotics, physiotherapy, and anti-tubercular treatment. The patient exhibited satisfactory recovery, and this case underscores the importance of comprehensive evaluation and prompt intervention in managing complex spinal infections.

Persistent Pain and Purulent Discharge: A Case of Infected Bipolar Hemiarthroplasty.

Prosthetic joint infection (PJI) remains a significant complication following joint arthroplasty, necessitating prompt recognition and intervention to optimize patient outcomes. This case report describes a 65-year-old male who presented with persistent pain, swelling, and purulent discharge from the right hip, three years post-bipolar hemiarthroplasty following a road traffic accident. Clinical examination revealed signs suggestive of PJI, prompting surgical intervention with total hip arthroplasty. Postoperatively, the patient experienced resolution of symptoms and satisfactory recovery. This case underscores the challenges associated with infected joint arthroplasty and highlights the importance of a multidisciplinary approach for effective management. Early diagnosis, appropriate surgical intervention, and comprehensive postoperative care are essential for minimizing morbidity associated with PJIs and optimizing patient outcomes.

Diagnosis and Management of Monostotic Fibrous Dysplasia of the Tibia in an Adolescent Patient: A Case Report.

A rare benign bone condition called monostotic fibrous dysplasia (MFD) is characterized by the growth of fibrous tissue in place of a normal bone. It may lead to deformity in the affected bone, pain, and a pathologic fracture due to bone weakness. Hereunder, a case report of MFD in a 17-year-old male adolescent presenting to the hospital with localized bone pain and swelling in his right tibia is presented. After clinical examination and radiographic imaging, a provisional diagnosis of benign osteolytic lesion was considered. A magnetic resonance imaging (MRI) scan of the leg suggested the possibility of fibrous dysplasia or adamantinoma. The patient was managed with an intralesional curettage of the dysplastic bone and packing the cavity with blocks of a synthetic bone. The excised material was sent for histopathology, which established the diagnosis of fibrous dysplasia.

A Comprehensive Review of Current Management Trends in Medial Compartment Arthritis of the Knee Joint.

Medial compartment arthritis of the knee joint presents a significant clinical challenge, with diverse management options ranging from nonsurgical interventions to various surgical procedures. This comprehensive review synthesizes current evidence on the management trends in medial compartment arthritis, highlighting both nonsurgical approaches such as physical therapy, pharmacological interventions, and intra-articular injections as well as surgical interventions, including arthroscopic debridement, high tibial osteotomy, and knee arthroplasty. Through a comparative analysis of efficacy, complication rates, and patient outcomes, this review underscores the importance of tailoring treatment strategies to individual patient characteristics and preferences. Furthermore, emerging techniques and technologies promise to advance the field, necessitating ongoing research efforts to refine treatment algorithms and establish standardized guidelines. By adopting a multidisciplinary approach and integrating evidence-based practices, clinicians can optimize the management of medial compartment arthritis and enhance patient care outcomes.

Study of Efficacy of Extraosseous Local Infiltration of Multimodal Drug Cocktail for Pain Management After Total Joint Arthroplasty in Lower Limb.

Background Osteoarthritis (OA) is a chronic debilitating condition involving joints that ultimately leads to chronic pain, restricted mobility, and functional impairment of the joint. The gold standard treatment of end-stage OA is arthroplasty. Following arthroplasty surgery, patients might have excruciating pain in the postoperative period. Our study aimed to evaluate the beneficial effects of a multimodal drug cocktail in patients who underwent arthroplasty surgery concerning postoperative pain and knee range of motion during the healing period. Materials and methods In this randomised case-control study, we enrolled 32 patients, of which 16 patients had knee arthritis and underwent total knee replacement. In contrast, the other 16 patients had hip arthritis and underwent total hip replacement. Randomisation was done using simple random sampling (envelope method), and patients were divided into groups A and B accordingly. Group A consists of a postoperative pain management modality using epidural analgesia with a top-up at a 12-hour interval. Group B consists of a postoperative pain management modality using an extraosseous multimodal drug cocktail consisting of clonidine, cefuroxime, tramadol, bupivacaine, adrenaline, and normal saline in specific quantities. Visual analogue scale (VAS) was assessed post-surgery for walking and resting. Joint range of movement and walking distance were assessed post-surgery and compared between the two groups. Results A total of 32 patients who had OA and underwent total knee arthroplasty (TKA) and total hip arthroplasty (THA) were selected and divided into case and control groups of eight, each by simple random sampling (envelope method). The mean preop VAS scores for the epidural and cocktail groups were 7.88 ± 0.61 and 7.44 ± 0.62, respectively, with p = 0.057, which is insignificant. However, when the groups were compared based on VAS score while standing at 24, 48, and 72 hours, the standing VAS score was found to be significantly higher among subjects, given epidural analgesia with p-values of 0.001, 0.001, and 0.001 at 24, 48, and 72 hours, respectively, which is significant in our study. Also, postoperatively, at 24, 48, and 72 hours, the mean degree of movement was found to be significantly higher among subjects, given cocktail analgesia with p-values of 0.013, 0.001, and 0.001, respectively. Conclusion As a result of early postoperative pain alleviation, the current study concludes that multimodal pain control procedures, which combine more than two medications with distinct mechanisms of action, successfully increase patient satisfaction. A multimodal medication conjunction administered locally to patients resulted in improved functional outcomes, faster recovery, and better rehabilitation.

A Comprehensive Review of Postoperative Analgesics Used in Orthopedic Practice.

Orthopedic surgeries, ranging from joint replacements to fracture fixations, are integral procedures that enhance the quality of life for countless individuals. Effective postoperative pain management is crucial in ensuring optimal patient recovery and satisfaction. This comprehensive review analyzes the diverse array of analgesic modalities employed in orthopedic practice for postoperative pain relief. The review systematically explores the pharmacological landscape of analgesics commonly used in orthopedic settings, including opioids, non-steroidal anti-inflammatory drugs, acetaminophen, and adjuvant medications. Emphasis is placed on their mechanisms of action, efficacy profiles, and potential adverse effects. Special attention is given to the evolving role of multimodal analgesia, which combines various agents to achieve synergistic pain control while minimizing individual drug-related complications. Furthermore, the review addresses the emerging trends and advancements in postoperative analgesia within orthopedics, such as integrating regional anesthesia techniques, peripheral nerve blocks, and novel pharmacological agents. A critical evaluation of evidence-based practices and recent clinical trials is incorporated to guide practitioners in making informed decisions regarding postoperative pain management. Consideration is also given to the individualized nature of pain experiences and the importance of patient-centric approaches. The review underscores the significance of tailoring analgesic regimens based on patient characteristics, surgical procedures, and potential complications, fostering a personalized and effective pain management strategy. In conclusion, this comprehensive review is valuable for orthopedic practitioners, anesthetists, and healthcare professionals involved in postoperative care. By synthesizing current knowledge and highlighting evolving trends, the review contributes to the ongoing dialogue on optimizing pain management strategies in orthopedic practice, ultimately improving patient outcomes and satisfaction.

Exostosis of Ulna With Developmental Deformity of the Left Forearm: A Rare Case.

This case report presents a rare occurrence of exostosis of the ulna associated with a developmental deformity of the left forearm in a 15-year-old female. The patient reported a history of trauma resulting in a supracondylar humerus fracture managed conservatively eight years prior. The patient presented with a two-year history of pain and swelling over the left forearm. Clinical examination revealed a firm, non-tender, immobile swelling closely associated with the ulna, accompanied by a 20-degree cubitus varus deformity and forearm shortening. Radiographs and computed tomography scans confirmed the presence of a solitary external bony protuberance over the ulna shaft, communicating with the medullary cavity. A preliminary diagnosis of osteochondroma was established based on clinical and imaging findings. The patient underwent extraperiosteal en bloc resection of the lesion under supraclavicular nerve block anesthesia. A histopathological examination confirmed the diagnosis. Postoperative physiotherapy was initiated, and at the one-month follow-up, the patient reported being pain-free. This case highlights the rarity of exostosis of the ulna with associated developmental deformity, emphasizing the importance of a comprehensive diagnostic approach. Early surgical intervention resulted in a successful outcome, underscoring the significance of timely management in improving patient outcomes and quality of life.

Giant Cell Tumor of Extensor Tendon Sheath in Ring Finger: A Case Report.

Giant cell tumour of the tendon sheath (GCTTS) is a rare benign soft tissue tumour with no known cause. It is more prevalent in the hand than in the ankle and foot. It appears as a non-painful, perceptible enlargement. Although pre-operative imaging and fine-needle aspiration cytology (FNAC) corroborate suspicion, histology following surgical resection is used to confirm the diagnosis. Due to its rarity, a case of giant cell tumour (GCT) of the extensor tendon sheath of the left ring finger is reported here. A 39-year-old female presented with a six-month history of painless swelling over left ring finger. The swelling was spontaneous, slowly progressive and painless. On clinical examination, a 1.5 cm x 1 cm firm swelling was seen on the dorsal surface of the left ring finger extending from the distal portion of the middle phalanx to the proximal half of the distal phalanx. The swelling was well-defined, smooth, firm, and uniform in consistency. The swelling was movable sideways with no attachment to the bone when examined clinically. X-ray of the hand showed soft tissue mass without the involvement of the bone. Soft tissue mass was seen on ultrasonography. An excisional biopsy was done. Histopathology showed typical features of GCTTS. Our case is a rare example of GCTTS in a single digit of the hand. Furthermore, considering its high recurrence risk, the tumour should be totally excised. Finally, if required, the hand's function should be recreated to minimise the loss.

Transient Hypertension in a case of Congenital Pseudarthrosis of Tibia treated with Ring Fixator: A Case Report.

Introduction: Congenital pseudarthrosis of tibia is an uncommon condition leading to gradually progressive deformity, shortening of the limb and disability. The condition is notorious for failure of treatment and need of multiple operations. A combination of open reduction, thorough excision of abnormal tissue at the pseudarthrosis site, intramedullary nailing, ring fixator application, and distraction to achieve bone equalization has proved successful. Case Report: A case of congenital pseudarthrosis of the left tibia and fibula associated with neurofibromatosis treated by open reduction, intramedullary nailing, ring fixator application, and distraction at corticotomy to cause compression at the pseudarthrosis site and limb length equalization is being reported due to uncommon occurrence of transient hypertension in the child as a complication of ring fixator. Conclusion: Transient hypertension is a rare complication seen in children after application of ring fixator. Its diagnosis and control require proper perioperative assessment of child regarding blood pressure (BP), monitoring of BP during distraction period and period of application of ring fixator, and its treatment under care of pediatrician.

Traumatic First Rib Fracture: An Indication of Life-threatening Injuries.

Introduction: First rib fracture is a very uncommon injury due to protection provided to it by clavicle. In isolation, it may be associated with neurovascular injury rarely but as part of poly trauma the first rib fracture may be associated with vascular injury in significant number of cases. There is definite role of computed tomography scan thorax in diagnosis of this fracture which can be missed on X-ray chest. Management includes early diagnosis of associated life-threatening complications and its prompt treatment. Case Report: A case of poly trauma associated with right first rib fracture with subclavian artery thrombosis resulting in gross ischemia of the right upper limb and fractures in the right upper limb and right lower limb long bones is reported. The patient developed signs of ischemia and lung complications 24 h later. Subclavian artery damage was diagnosed on Doppler ultrasound and angiography. The case was managed by surgical repair of subclavian artery damage and stabilization of fractures. Conclusion: The case is reported to highlight association of first rib fracture with life-threatening complication of subclavian artery laceration causing extensive swelling around shoulder, ischemia to the right upper limb, lung damage, and problem of its detection and management.

Limb Salvage Surgery With Mega-Prosthesis in a Case of Chondrosarcoma: A Case Report.

Chondrosarcoma is a kind of bone tumor that can be anywhere in the body but most commonly affects the pelvis, glenohumeral joint, proximal femur, and proximal one-third of the tibia including condyles. It accounts for 20-25% of all bone sarcomas. Chondrosarcomas with clear cell variants are extremely uncommon, making up just around 6% of all cases. We are presenting a case of a 52-year-old male with a bony lesion over the epiphysis of the left tibia. He was managed with resection of the tumor followed by a limb salvage procedure with mega-prosthesis. Chondrosarcoma affects men in the third to fourth decades of their life more commonly than females. Long-standing localized pain over a prolonged duration is the most common presenting symptom. There are various treatment modalities available for clear cell chondrosarcoma, ranging from wide local resection and intralesional therapy to amputation. The decision of tumor resection followed by prosthesis was chosen over amputation here, as the patient had the lesion for 2 years and there were no signs suggestive of metastasis after thorough screening. Limb salvage gave a better outcome for the patient in our study. A large-segment prosthesis is a suitable reconstructive alternative to amputation. At the majority of the anatomical sites where the prosthesis was employed, the functional results were good or exceptional after this type of treatment. The patient now has a functional limb and is able to resume his life as before, making mega-prosthesis a better alternative and treatment of choice for patients with large lesions.

A Review on the Efficacy of Extraosseous Local Infiltration of Multimodal Drug Cocktail for Pain Management After Total Knee or Hip Arthroplasty.

Total knee arthroplasty (TKA) patients express minimal comfort regarding postoperative pain management. The use of parenteral opioids or epidural analgesia may have unfavorable adverse impacts that interfere with quick healing and rehabilitation. It is uncertain if periarticular multimodal drug injections (PMDI) are effective at easing pain following total knee or total hip arthroplasty (THA). We conducted this study to assess the effectiveness of PMDI following TKA or THA. Articles were sourced using the following keywords on Pubmed, Google scholar, and the Web of Science: multimodal drug cocktail in total knee arthroplasty OR hip arthroplasty, periarticular injections AND multimodal drug cocktail, epidural versus periarticular injections AND pain management after total joint arthroplasty. After screening 438 articles and abstracts, 200 pertinent studies were found, of which a total of 10 articles were included in the study. From this review, we want to conclude that despite the various ways to address postoperative pain, there is no acknowledged gold standard for postoperative pain management following total joint arthroplasty. To reduce narcotic intake and prevent narcotic-related adverse reactions, multimodal techniques utilizing regional anesthetics appear to be on the rise such as periarticular injections, or patient-controlled analgesia with or without femoral nerve block. Even though the ideal duration and kind of medications are unclear, preoperative pain management or preemptive analgesia with anti-inflammatory drugs and opioid analgesics seem to be useful in lowering postoperative pain.

Psychosocial and Behavioral Effects of the COVID-19 Pandemic in the Indian Population: Protocol for a Cross-sectional Study.

BACKGROUND: During the year 2020, the COVID-19 pandemic spread from China to the rest of the world, which prompted the world to implement a widespread mandated quarantine or social isolation. The impending uncertainty of the pandemic must have resulted in a variety of widespread mental health maladies. There has been documentation in the literature about a lot of these in small populations of the world but limited studies have been conducted in India, leading to limited evidence in the literature. OBJECTIVE: The main objective of our study is to investigate the mental health effects that the COVID-19 pandemic has had on the general population in India both quantitatively and qualitatively. These results will help contribute to reducing the knowledge gap that is recognized in the literature, which is the result of the unprecedented and novel nature of the pandemic. METHODS: We designed and validated our own questionnaire and used the method of circulating the questionnaire via WhatsApp (Facebook Inc). WhatsApp is a social media app that is very popularly used in India; hence, it turned out to be an effective medium for gathering pilot data. We analyzed the pilot data and used them to validate the questionnaire. This was done with the expertise of our mentor, Nilima Shah, MD (psychiatry). We gathered pilot data on 545 subjects and used the results to determine the changes that were needed for the questionnaire while simultaneously validating the questionnaire. RESULTS: The study protocol was approved in September 2020 by the institutional review board at Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India. CONCLUSIONS: The following preliminary assumptions can be made about the study based on the pilot data: the majority of the survey respondents were male (289/545, 53%), most of them were educated and employed as health care workers (199/545, 36.5%). The majority of the responders were self-employed (185/545, 33.9%), single (297/545, 54.5%), and stayed with their families (427/541, 79%) for the lockdown, which helped them psychologically. Findings that are specific to mental health have been elaborated upon in the manuscript. It is evident from the data collected in previous literature that the pandemic has had significant detrimental effects on the mental health of a vast proportion of the Indian population. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/29896.