Management of Neglected Locked Anterior Shoulder Dislocation in the Elderly Population in an Indian Scenario - A Case Report.

Introduction: There is a paucity of literature regarding a neglected shoulder dislocation, as it is unusual to miss it clinically due to the apparent deformity. Nevertheless, in some cases, particularly those who receive primary treatment from a local bonesetter, they may present with a neglected shoulder dislocation. In the absence of comprehensive studies, health-care professionals have to resort to lower-tier evidence and practical experience to guide their treatment decisions. Therefore, most of the treatment recommendations are based on level four studies and the literature for recurrent dislocation of the shoulder. Case Report: We have described three cases of neglected anterior dislocation of the shoulders in two patients, which were managed by open reduction, Latarjet procedure, remplissage, and rotator cuff repair. Both of our patients after 1-year follow-up had a painless joint with an improved functional range of motion. This case discussion contributes to understanding the approach to treating these patients. Conclusion: Recurrent shoulder joint instability with bone loss in the younger and older age groups has to be managed differently. Based on this case report involving individuals older than 50 years, it can be inferred that the approach to managing neglected locked shoulder dislocations with off-track lesions is with open reduction and fixation with Latarjet procedure, coupled with RCR and remplissage, has yielded adequate joint stability and favorable post-operative outcomes.

Trifocal Injury of the Patellar Tendon- An Exceedingly Rare Case Report.

Introduction: Distal pole of patella avulsion fracture with tibial tuberosity avulsion has been frequently reported as a bifocal patellar tendon injury. However, an osteochondral lateral patella facet fracture with a longitudinal split in the patella tendon in addition to these avulsion fractures has never been documented previously. Hence, we now report this trifocal patellar tendon injury. Case Report: An adolescent with a trifocal patella tendon injury underwent a fixation with a combination of transosseous pull- through sutures, suture tape, and knotless anchor. The patient was rehabilitated with gradual increase in 30° of knee flexion weekly and has now attained full knee range of motion. Conclusion: Fixation of the small avulsion fracture can be challenging using conventional methods such as cannulated cancellous screws especially in an immature skeleton as it can crush the fragments. Suture tape, transosseous tunnels, and knotless suture anchors have more flexibility, they avoid the physis and provide adequate strength in such situations compared to metallic implants.

Arthroscopic meniscus repair and augmentation with autologous fibrin clot in Indian population: A 2-year prospective study.

Introduction: This study was proposed to evaluate the efficacy of fibrin clot augmentation in meniscal tear using inside-out meniscal repair. Methods: A total of 35 patients with meniscus tears were operated on with inside-out meniscus repair and fibrin clot augmentation. Patients were evaluated preoperatively and postoperatively with clinical criteria, Lysholm knee scoring system, and MRI. Results: Out of the total 35 cases, 5 cases were lost to follow-up. Clinical improvement was observed in 29 out of 30 patients (96.6%). The mean Lysholm score improved significantly from 67.63 ± 6.55 points preoperatively to 92.0 ± 2.9 points postoperatively (P < 0.05) in 3 years follow-up. Follow-up MRI in all patients revealed complete healing except in 1 case where the patient presented with recurrence of symptoms such as pain and locking which resolved with partial meniscectomy. Paraesthesia in the anterior part of the knee was observed in 2 cases. (6.6%). Conclusion: We conclude that fibrin clot augmentation is a good cost-effective modality of treatment for repairable meniscus tears to preserve the meniscus and decrease the point contact pressure on the condyles which may prevent the early occurrence of osteoarthritis.

Platelet-Rich Plasma Has Better Long-Term Results Than Corticosteroids or Placebo for Chronic Plantar Fasciitis: Randomized Control Trial.

Plantar fasciitis is the most common cause of heel pain. Platelet-rich plasma (PRP) is a supersaturated concentration of autologous platelets that augments the natural healing response of fascia. Previous studies have shown the superiority of PRP over corticosteroids (CS) for chronic plantar fasciitis. The aim of this study was to compare the pain and functional outcomes of PRP with CS and placebo injections for the treatment of chronic plantar fasciitis. We conducted a 3-arm randomized controlled trial of 90 patients: PRP (n = 30 patients), CS (n = 30 patients), and placebo (n = 30 patients). The patients were followed at regular intervals until 18 months postinjection using validated instruments. The mean visual analog scale score showed significant improvement in all groups between baseline and 18-month follow-up (PRP: 8.2 vs 2.1; CS: 8.8 vs 3.6; placebo: 8.1 vs 5.4), with CS showing significantly better improvement than PRP in the short term, whereas longer-term PRP was significantly better than CS. The mean Roles and Maudley score showed significant improvement in all groups between baseline and 18-month follow-up (PRP: 1.7 vs 3.7; CS: 1.2 vs 3.1; placebo: 1.2 vs 2.0), with CS showing significantly better improvement than PRP in the short term, whereas longer-term PRP was significantly better than CS. The mean Short Form 12 score showed significant improvement in all groups between baseline and 18-month follow-up (PRP: 55.4 vs 80.2; CS: 56.2 vs 76.2; placebo: 54.1 vs 62.4). We found that all 3 groups showed significant improvement between baseline and end of the follow-up period with regard to pain, function, and general health. The CS arm showed better improvement in the short term, whereas the PRP arm showed better results in the long term. In contrast to previous studies, we found no significant drop-off effect of CS in the long term, which may be owing to background natural healing process of the disease. In summary, both PRP and CS are safe and effective treatment options for chronic plantar fasciitis, showing superior results to placebo treatment. The longer-term results and less reinjection and/or surgery rate of PRP makes it more attractive as an injection treatment option versus CS injection.

Total knee arthroplasty in vascular malformation.

In Klippel-Trenaunay syndrome, vascular malformations are not only in skin and superficial soft tissues but also in deep tissues like muscles bones and joints. It is well documemted that these recurrent intraarticular bleeds can cause early arthritis and joint pain. Performing arthroplasty in such patients is difficult and fraught with complications. We describe such a case where navigated total knee arthroplasty was performed with success to avoid the problems of intra medullary alignment used in the presence of intra medullary vascular malformations. We also suggest certain measures when knee arthroplasty is considered in such patients.