Dual Joystick Technique for Reduction of Torsional Profile in Pediatric Supracondylar Humerus Fracture With Delayed Presentation.

BACKGROUND: Reduction of some modified Gartland type III and IV supracondylar humerus fractures can pose difficulties, especially if they present late to the hospital. Various techniques of reduction have been tried for reducing the supracondylar humerus fracture for sagittal and coronal plane correction. This retrospective study assesses the dual joystick technique's possible effectiveness in achieving an anatomical reduction of the supracondylar humerus fracture. METHODS: Patients with modified Gartland's type III and IV supracondylar humerus fractures who underwent closed reduction and percutaneous pinning using the dual joystick technique at our trauma center between January 2020 and January 2022 were the subject of a retrospective review. Forty-six patients treated by the above technique who met the inclusion criteria were analyzed at the end of the final follow-up. RESULTS: The mean age of the children was 7.9+/- 2.25 years, with a male predominance at 32:14. The Right upper limb was more involved compared to the left side. The mean injury to hospital presentation was 2.67+/- 1.28 days, and the mean surgical duration was 24.57+/- 13.76 minutes. The average pin spread ratio at the fracture site was 35.17+/- 3.04%. Baumann angle at the final follow-up was 74.83+/- 2.56 degrees. The mean lateral rotation percentage was 2.8+/- 1.3%. 39 patients had excellent cosmetic outcomes, and 42 had excellent functional outcomes, whereas 7 and 4 patients had good cosmetic and functional outcomes, respectively, according to Flynn criteria. CONCLUSIONS: In modified Gartland type III and IV fractures with late presentation where reduction is challenging, this technique is shown to be convenient and easily reproducible and helps accomplish near anatomical reduction with reduced lateral rotation percentage and results in excellent to good outcomes.

Can gabapentinoids decrease perioperative opioid requirements in orthopaedic trauma patients? A single-centre retrospective analysis.

INTRODUCTION: Perioperative pain control in patients with orthopaedic trauma/extremity fractures has gained a lot of attraction from the scientific community in the last two decades. In addition to multimodal analgesia, the use of non-opioid drugs like gabapentinoids for pain relief is gradually finding its place in several orthopaedic subspecialties like spinal surgery, arthroplasty, and arthroscopic procedures. We envisage investigating the effectiveness of gabapentin in perioperative pain control in patients with extremity fractures undergoing surgical fixation. METHODOLOGY: This was a retrospective comparative study conducted between January 2020 and January 2022. Patients with isolated fractures of the extremity involving long bones who were treated at our trauma centre, during the study period were divided into two groups based on the analgesics they received. Patients who received gabapentin and paracetamol were placed in group GP and those who received only paracetamol were assigned group NGP. Gabapentin was given in a single dose of 300 mg 4 h before surgery. Postoperatively, they were given 300 mg 12 hourly for 2 days. All patients in our trauma centre are usually managed with parenteral paracetamol administration pre and postoperatively. VAS score was calculated postoperatively at 2, 6, 12, 24 and 48 h. Patients requiring additional analgesics for pain relief were administered intravenous tramadol or a buprenorphine patch was applied. Patients in both groups were compared in terms of pain control, the additional requirement of opioid analgesics, and any adverse event related to medications. RESULTS: One hundred and nineteen patients were enrolled in the study. Out of 65 patients in the NGP group (non-gabapentin group), 74% of patients received additional opioid analgesics apart from paracetamol. Out of the 54 patients in the GP group (gabapentin group), only 41% required additional opioid analgesia for pain control. There was a significant difference in opioid consumption between the two groups (p < 0.01). VAS scores were not significantly different between the two groups at 2, 4, 6, 12, 24 and 48 h. Gender and fracture morphology did not affect opioid intake in the GP group. However, in the non-gabapentin group, there was a significant difference in opioid requirement in patients with intraarticular fractures (p < 0.01). CONCLUSION: Analgesic requirements vary from patient to patient depending on the injury's severity and surgery duration. However, there are no strict guidelines for pain relief in limb trauma surgeries which often leads to overuse and opioid-related complications or underuse and chronic pain. Gabapentinoids can supplement the analgesic effect of paracetamol in trauma patients during the perioperative period, decreasing the need for opioids.

Synovial Chondromatosis Ankle - A Case Report.

Introduction: Many loose bodies are present in the joint due to the uncommon benign neoplastic disorder known as synovial chondromatosis, which causes the production of intra-articular nodular cartilaginous lesions from the synovium. Synovial chondromatosis of the ankle joint is an uncommon condition. Here, we present a case of synovial chondromatosis of the ankle joint treated by surgical excision. Case Report: A 42-year-old woman who had been experiencing discomfort and edema in her left ankle for 8 years and had gotten worse during the previous 2 years visited our outpatient department. Clinical and radiological examination revealed synovial chondromatosis of the left ankle joint. Conclusion: Synovial chondromatosis of the ankle is an uncommon synovial neoplasm in an unlikely anatomic location. The diagnosis should be considered when evaluating monoarticular synovitis.

A Comparative Analysis of Commonly Used Surgical Approaches for Anterior Acetabular Fractures.

Introduction Fractures of the acetabulum are inherently complex due to the anatomy of the innominate bones and also the presence of several vital neurovascular structures in the vicinity. Thus, the treatment of pelvic ring and acetabulum fractures is riddled with complexities and is considered among the most challenging surgeries for an orthopedic surgeon. When anterior access is necessary, such as in the anterior column, both columns, anterior column posterior hemitransverse, transverse, and T-type fractures, both the ilioinguinal and the anterior intrapelvic (AIP) or modified Rives-Stoppa methods are employed. The aim of this study is to compare the results from acetabular fractures treated with a modified Stoppa and ilioinguinal technique. Materials and methods We conducted a prospective cohort study to compare the outcomes of anterior acetabular fracture fixation using the modified Stoppa approach and the ilioinguinal approach. The outcomes measured were the amount of intraoperative bleeding, surgery duration, postoperative quality of fracture reduction, postoperative drain collection, and postoperative neurovascular status. The functional outcome was measured at three, six, and 12 months using the Merle d'Aubigné score. The radiological outcome was measured using the Matta scoring system. Results A significant difference was noticed in the two groups in the average blood loss and surgical duration, where the mean blood loss was 911.67 ± 143.05 ml in the ilioinguinal approach and 748.33 ± 165.30 ml in the modified Stoppa approach. While the ilioinguinal approach had a mean surgical duration of 190.33 ± 29.42 minutes, the modified Stoppa approach had 151.33 ± 23 minutes. The difference in postoperative fracture reduction in both groups was insignificant. The lateral femoral cutaneous nerve was compromised in 8.33% of cases in group A. The obturator nerve was compromised in 6.67% of cases in group B. The postoperative functional outcome was assessed by the modified Merle d'Aubigné score, and the radiological outcome was evaluated by the Matta score. The results obtained in both our study arms were comparable. Conclusion Based on our results, we can safely advocate the superiority of the Stoppa approach over a more extensive ilioinguinal approach. By virtue of being shorter in surgical duration and causing lesser blood loss, the Stoppa approach seems to be a better alternative, especially in elderly or polytrauma patients. As no difference was noted in the postoperative outcomes both clinically and radiologically, no approach showed superiority over the other in terms of patients' eventual functional outcomes.

Outcomes of Osteoid Osteoma Treated by Percutaneous CT-Guided Radiofrequency Ablation.

Introduction Osteoid osteomas are the most frequent true benign bone tumor in the adolescent age group and the third most prevalent benign bone tumor overall. This study was designed to assess the effectiveness of the procedure and correlate it with the analgesia offered because of the significant burden of this illness and new literature supporting the successful outcomes of image-guided percutaneous radiofrequency ablation (RFA) in osteoid osteoma. Methodology  This hospital-based interventional trial was carried out in a tertiary care referral center. Forty-two patients with osteoid osteoma, ranging in age from 9 to 30, were included in the study. The patients received RFA guided by computed tomography (CT), and they were postoperatively monitored at one, two, and four weeks and three, six months, and 12 months. A numerical pain scale (NPS) was used to evaluate the patient's pain both before and after the procedure. The preoperative and postoperative results were contrasted. Results A total of 42 participants were enrolled in the study. Eight (19.05%) women and 34 (80.95%) men made up the group. Complete pain alleviation (NPS=0) was attained in 42.8% and 96.4% of the study group in the first and second weeks post-procedure. Almost all patients began protected weight-bearing at one week, according to their level of pain tolerance. Osteoid osteoma of the talus was a remnant lesion in one patient that required further treatment after two weeks. During the duration of the follow-up, no problems were recorded. Conclusion Percutaneous CT-guided RFA of osteoid osteoma is a safe, minimally invasive procedure and greatly reduces the duration of hospitalization. It has excellent functional outcomes and no known complications.

Intra-articular osteoid osteoma of the hip mimicking as monoarthritis-A case report.

Introduction: Osteoid osteoma is a common benign bone tumor affecting young adults with the typical clinical and radiological presentation when arising from common locations. However, when they arise from unusual locations like intra-articular regions the diagnosis may be confusing thereby leading to delay in diagnosis and appropriate management. Here we present a case with an intra-articular osteoid osteoma of the hip involving the anterolateral quadrant of the femoral head. Case Report: An active 24-year-old man, with no relevant or significant medical history presented with progressive left hip pain radiating to the thigh for the past 1 year. There was no significant history of trauma. His initial symptoms were dull aching groin pain which worsened over weeks, associated with night cries, and loss of weight and appetite. Conclusion: The unusual site of presentation led to a diagnostic challenge and caused a delay in diagnosis. Computed tomography scan is the gold standard to detect osteoid osteoma and radiofrequency ablation can be used as a reliable and safe modality of the treatment for intra-articular lesions.

Recurrent Intra-articular Synovial Hemangioma - A Case Report.

Introduction: Synovial hemangioma is a rare benign condition that is seen predominantly in the adolescent age group. Patients commonly present with pain and swelling of the involved joint. Here, we report a case of recurrent synovial hemangioma in a 10-year-old girl. Case Report: A 10-year old presented with complaints of recurrent swelling in her right knee of 3 years duration. She had complaints of pain, swelling, and deformity of her right knee. She had undergone a surgery to excise the swelling earlier for similar complaints elsewhere. She remained asymptomatic for a year, after which swelling reappeared. Conclusion: Synovial hemangioma is a rare benign condition that is often missed and needs to be promptly addressed to prevent damage to the articular cartilage. The chance of recurrence is high.

Proximal Phalanx Enchondroma with Pathological Fracture Treated with Curettage and Bone Substitute Placement - A Case Report.

Introduction: Enchondromas are predominantly seen in short tubular bones and are usually symptomless and the onset of pain may indicate a pathological fracture in most cases or malignant transformation in rare instances. Here, we report a case of proximal phalanx enchondroma with pathological fracture treated with synthetic bone substitute placement. Case Report: A 19-year-old girl presented to the outpatient department with complaints of swelling over the right little finger. She was evaluated for the same and a roentgenogram revealed a well-defined lytic lesion in the right little finger proximal phalanx. She was planned for conservative management, but she presented 2 weeks later with an increase in pain following trivial trauma. Conclusion: Synthetic bone substitutes are excellent materials for filling the void in benign conditions as they form resorbable scaffolds which have good osteoconductive properties and are associated with no donor site morbidity.

Ochronotic hip arthropathy - A case report.

Introduction: Ochronotic arthropathy is a rapidly progressive sequelae of alkaptonuria. This is a rare autosomal recessive condition caused by a mutation in the homogentisate 1,2 dioxygenase (HGD) gene leading to HGD enzyme deficiency. Here, we report a case of neck femur fracture in a patient with ochronotic arthropathy managed by primary hip arthroplasty. Case Report: A 62-year-old gentleman presented with complaints of pain in his left groin area and difficulty in weight bearing on his left lower limb for 3 weeks. The pain was sudden in onset and started while he was on his morning walk. He did not have any problems with his left hip before this episode and he did not give a history of any significant trauma. History, radiological, and intraoperative findings revealed ochronotic hip arthropathy. Conclusion: Ochronotic arthropathy is relatively rare and is seen in isolated communities. The treatment options are similar to primary osteoarthritis and the outcome is comparable to arthroplasty done for osteoarthritis.