Angle Stable Plate Fixation vs Hemicallotasis in Medial Opening Wedge High Tibial Osteotomy: A Comparative Study.

Background: Varus alignment associated with medial compartment degeneration is the most common presentation of knee osteoarthritis and often presents in young active adults where arthroplasty might be unsuitable. Purpose: To compare the accuracy of the angle stable medial high tibia plate and self-adjusting HTO (high tibial osteotomy) fixator in achieving correction of varus deformity of the knee by medial opening wedge HTO and to evaluate functionality between the groups. Study Design: Prospective randomized control study. Methods: Forty patients each underwent medial opening wedge high tibial osteotomy with acute correction and stabilization using the angle stable plate (ASP group) or with the hemicallotasis technique using the self-adjusting HTO external fixator (HCO group). Anatomical and functional outcomes were compared to the pre-operative values at the 6th and 12th month. Results: The FTA (femoro-tibial axis), mechanical axis, and functional scores improved significantly in both groups. There was also a significant change in the patellar height and tibial slope. Except for a better KOOS (Knee Injury and Osteoarthritis Outcome Score) in the angle stable plate group at the 6-month follow-up, there were no significant differences between the groups. Conclusion: Both methods of performing a medially based proximal tibial osteotomy gave equivalent outcomes at the 1-year follow-up.

Efficacious Enactment of Ilizarov for Mangled Forearm: A Case Report on Our Resolution for the Revitalization of a "Nearly Lost Limb".

Introduction: Mangled is the evocative term for a grievance caused by crushing, resulting in a limb confiscation. Motor vehicle crashes and industrial/farm accidents are the leading causes of such occurrences. The verdict to reconstruct or to amputate still commonly lies with the surgical skills and experience of the treating surgeon. Case Report: We present a case of 33-year-old male military personnel involved in a road traffic accident who presented to our center with a mangled forearm with segmental fracture radius and fracture shaft of ulna with vascular injury. He was immediately taken up for early debridement, intramedullary fixation, vascular repair, and temporizing skin graft. After definitive soft-tissue flap coverage and a period of convalescence, the patient underwent Ilizarov external fixator application with successful rehabilitation. The patient achieved pain-free limb with functional range of motions of both elbow and wrist with functional capabilities of basic needs and activities of daily living. Conclusion: The combination of osseous, vascular, soft-tissue, and nerve injury after severe trauma to an extremity is a great challenge in the mangled extremity. However, in young patients without significant systemic involvement and borderline injury scores, limb salvage should be attempted.

A Type IV Tibial Tuberosity Avulsion Fracture in an Adolescent - A Case Report.

Introduction: Tibial tuberosity avulsion fractures in adolescents are one of the rare physeal injuries. Sudden powerful contraction of quadriceps muscle leads to avulsion fractures and varying degrees of disruption of extensor mechanism. Case Report: A 16-year-old boy sustained tibial tuberosity avulsion fracture while playing football and presented with sudden onset of pain, massive swelling, and loss of active extension of the left knee along with inability to bear weight on the left leg. Due to imminent risk of development of compartment, patient was taken for surgical correction immediately. Open reduction and internal fixation were done using 02 × 4 mm partially threaded cannulated cancellous screws. Patient was immobilized with above knee cast and kept non-weight bearing for 6 weeks. Later, gradual weight bearing ambulation was allowed and ROM and strengthening of knee was carried out. Patient had regained complete ROM of knee and returned to sporting activities by end of 6 months. Conclusion: Tibial tuberosity avulsion fractures are a rare occurrence and even rarer is them getting complicated by compartment syndrome. A high index of suspicion for development of compartment syndrome in an avulsion fracture of tibial tuberosity and a timely management can avert such potential complications and enables to achieve an optimal results.

Management of Soft-tissue Defects of Hand in a Conflict Combat Zone: A Case Series.

Introduction: Managing soft-tissue defects of hand is a challenging problem for any surgical team, even more in a field hospital setting of a conflict combat zone, where resources are scarce and such cases due to blunt trauma, gunshot wound and deep tissue infections are common. Case Report: We present four different cases, all middle aged males, who sustained injuries due to crush, low velocity gun shot, and defects post-debridement of acute onset infections following abrasions. The first patient was managed with doubled pedicled abdominal flap, the second patient was managed with external fixation for fracture, and cross finger flap for the defect. The third and fourth patients had similar presentations of acute onset deep soft tissue and bony infection, out of which one was managed with full thickness skin graft from anterior abdominal wall and the other with bi-pedicled abdominal flap. All the patients had good functional outcomes with no functional restrictions at follow-up of 12 weeks. Conclusion: All the cases were performed in a challenging situation of a highly active combat field zone, with limited resources and lack of availability of a trained hand surgeon. An early soft-tissue coverage, as soon as possible, was crucial in saving the hand function and guaranteeing a speedy return to function in view of lack of a professional hand surgery team and specialized microsurgery equipment.

Retrieval of broken intra-medullary guide wire in femoral shaft fracture: A case report and surgical technique.

Intramedullary Nailing is a standard procedure for fixation of various fractures in orthopedic practice. With the procedure also important is being aware of the complications and methods of managing them. A broken or stuck hardware can result in these procedures. We present a case with broken guide wire in a case of femoral shaft fracture in a young individual and the technique we used to retrieve it retrogradely from the fracture site. This technique shall be a useful technique to all the orthopedic surgeons if such a situation arises.

Atraumatic Reciprocal Scapula Fracture - A Case Report and Review of Literature.

Introduction: Scapula fractures are very rare and bilateral reciprocal involvement is rarest of all. Due to the protective nature of surrounding musculature, it is least prone to fracture with reported incidence of 1% of all skeletal fractures. However, synchronized firing of the periscapular muscles could overcome the bone strength resulting into the fracture as in the cases of electrocution and seizure attack. Case Report: We present a case of 54-year-old ex-military male patient with a history of acute onset seizure of multiple episodes. Magnetic resonance imaging showed cerebrovascular thrombosis. The patient was admitted in the intensive care and complained pain over bilateral shoulder with restricted movement in the post-ictal phase. X-ray showed bilateral comminuted extra-articular scapular fractures. The severity of the injury and displacement of the fracture pronounced operative intervention. Modified Judet approach was used to approach the fractures. After a successful surgery, rehabilitation protocol constituted of passive range of motion exercises with gradual active exercises of shoulder. One-year follow-up showed good consolidation of both fracture with full recovery of function. Conclusion: Periscapular musculature protects the scapula from traumatic events due to the significant bulk that it provides but these can on the other hand be source of deforming force in the patient who has history of simultaneous contraction as in the case of recurrent episodic seizure or electrocution. Scapular fracture should always be suspected in the patient with insidious development of shoulder pain following strong seizure attack. These fractures if indicated should be managed operatively.

Pediatric Traumatic Hip Dislocation: How Common is it in the Asian Population? A Case Report and Review of Literature.

Introduction: Pediatric hip dislocation is a rare event in the pediatric population. The management involves a timely diagnosis and emergent reduction for successful outcome. Case Report: We present a case of a 2-year-old male patient with a posterior dislocation of hip. The child underwent an emergent closed reduction using Allis maneuver. Subsequently, the child had an uneventful recovery and resumed his functional activity completely. Conclusion: Posterior hip dislocation in a child is an extremely rare entity. The key to management in such a case is to timely diagnose and reduce it.

Late Presentation of Giant Osteochondroma of Talar Neck in Elderly: A Case Report and Review of Literature.

Introduction: Osteochondroma is a benign bone tumor of the bone primarily seen in younger age groups. However, late presentation of the same is a rare incidence, as the symptoms develop rapidly due to compression of nearby structures. Case Report: We present a case of a 55-year-old male patient with a giant osteochondroma originating from the neck of the talus. The patient presented with a huge 100 × 70 × 50 mm swelling over the ankle. The patient underwent an excision of the swelling. Histopathological examination of the swelling confirmed the findings of an osteochondroma. The patient had an uneventful recovery after the excision and resumed his functional activity completely. Conclusion: Giant osteochondroma around the ankle is an extremely rare entity. Even rarer is a late presentation in the 6th decade onward. However, the management like others involves the excision of the lesion.

Osteopenia in Scaphoid Fracture: An Indicator of Good Prognosis or Is it Cause for Concern?: A Case Report.

CASE: A 32-year-old man sustained a scaphoid waist fracture and was managed nonoperatively in a short-arm cast. Radiographic follow-up at 6 weeks showed marked loss of radiodensity of the whole scaphoid, although the fracture was clinically united. Patchy ossification at 3 months was followed by the complete restoration of radiodensity and trabecular pattern by 20 weeks. The patient had an uneventful and full functional recovery. CONCLUSION: This, perhaps unreported, finding seems to be an indicator of preserved vascularity in scaphoid fractures. Further research/reporting of this radiological pattern in these fractures will help improve their understanding and management.

Changes in lower limb alignment and their effect on the functional outcome after treatment of varus degenerative OA knee by hemicallotasis using modular dynamic HTO fixator.

OBJECTIVE: High tibial osteotomy (HTO) is an established procedure to treat medial compartmental osteoarthritis (OA) knee associated with varus deformity. It is well documented that precise correction of deformity and maintenance of correction achieved is important to ensure long term good results. This study was undertaken to record changes in radiological parameters and its effect on the functional outcomes in first two years following HTO done for varus degenerative OA kneeby hemicallotasis technique using HTO fixator. METHODS: 31 patients meeting our inclusion-exclusion criteria who underwent HTO by hemicallotasis method using self-adjusting unilateral HTO fixator were included in the study. Their femoro tibial angle (FTA), mechanical axis %, Insall- Salvati ratio, proximal tibial antero-posterior slope and knee injury and osteoarthritis outcome Score (KOOS) were recorded preoperatively, postoperatively at the time of removal of fixator, at 1 year and at 2 years. RESULTS: The FTA and mechanical axis significantly improved from a mean of 183.12° and -3.26% respectively preoperatively to 173.38° and 61.81% at the time of removal of fixator but subsequently showed significant deterioration to 176.06° and 57.96% at 1 year and further insignificant deterioration to 176.16° and 57.74 at 2 years. The KOOS improved from mean 56.61 preoperatively to 70.48 at the time of fixator removal and further improved significantly to 85.68 at 1 year but significantly deteriorated to 84.54 at 2 years. The Insall-Salvati ratio, tibial slope showed no significant change throughout the study. Conclusion: Though desired alignment can be achieved by using the fixator, we found a significant deterioration in achieved radiological parameters after removal of fixator adversely affecting the functional outcome which is a matter of concern.

Assessment of awareness and barriers to clubfoot treatment in the Indian scenario.

BACKGROUND: We undertook this study to evaluate the awareness of the Primary Caregivers of children with clubfoot aka Congenital Talipes Equino Varus (CTEV) and their familiarity with the disease, their beliefs, knowledge and compliance to treatment, and barriers encountered during the treatment process. SETTINGS AND DESIGN: Cross-sectional, analytical study. MATERIALS AND METHODS: A standard questionnaire in the local vernacular language was prepared, on which 108 respondents were interviewed. Data were analyzed by using Statistical Package for the Social Sciences (SPSS) software program, version 21.0. Chi-square test was applied wherever suitable as a parametric test. RESULTS: Approximately 57.40% of participants had no prior knowledge of clubfoot at all, till they had a child born of the deformity in the family. Superstitions like lunar eclipse (37.96%), punishment from God (37.03%), solar eclipse (34.26%) and black magic (26.85%) were widely prevalent as the perceived cause of the deformity. Only 25% of the participants believed that any kind of treatment should be started immediately after birth and 20.37% of the study population felt the first line of treatment should be a visit to a spiritual healer or to a shrine of a saint. Approximately 68.52% of the study participants were satisfied with the explanation of the disease process and treatment plan offered by the treating doctor. Approximately 52.77% perceived social stigma as an obstacle to treatment, whereas 58.33% had difficulties adjusting to change of home or workplace routines. CONCLUSION: The awareness level regarding clubfoot in the primary caregivers in the Indian scenario is low and has an implication on successful treatment and compliance.