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1.
J Orthop Case Rep ; 9(6): 36-39, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32548025

RESUMO

Introduction: The ganglion cysts are benign fluid-filled sacs, which often arise from a tendon sheath or a joint capsule. Their origin from the fat pad of the knee is rare. Several studies have described intra-articular ganglion cysts in detail; however, extra-articular soft-tissue ganglion cysts have been reported sparingly. We report a rare case of giant ganglion cyst arising from lateral Hoffa's fat pad (HFP). Case Report: A 59-year-old male patient presented with a 3-year history of swelling of the left knee, with occasional pain. There was no history of trauma or any constitutional symptoms. There was an apparent swelling (10 cm ×5 cm in size) around the anterolateral aspect of the knee joint. A magnetic resonance imaging (MRI) scan revealed a multilobular, complex cystic lesion of the lateral HFP. Surgical excision of the cyst was done, and histopathological examination confirmed the diagnosis of the ganglion cyst. Conclusion: Cysts and cystic-appearing lesions around the knee are not uncommon, but a ganglion cyst arising from HFP is rare. The presence of multipotent cells in the HFP may be responsible for producing a variety of cyst and cyst-like tumors around the anterior aspect of the knee joint. An MRI is the best imaging modality for the diagnosis of these cysts and cysts-like lesions around the knee. We recommend that the smaller intra-articular lesions can be resected arthroscopically, but larger lesions, with extraarticular extension, are best treated by open resection to avoid incomplete excision and recurrence.

3.
J Clin Orthop Trauma ; 10(6): 1121-1127, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31708639

RESUMO

Osteochondritis dissecans (OCD) of the knee joint affects subchondral bone first, and then it involves the articular cartilage. It can cause pain, effusion and loose body formation. Nonoperative treatment is for the stable lesion, but if the lesion is unstable and symptomatic, then operative management is needed. Short term goal of the treatment is pain relief, and the long-term goal is the prevention of early arthritis. Surgical treatment includes removal of loose body, microfractures, osteochondral autograft and allograft transplantation, autologous chondrocyte implantation (ACI), arthroscopic removal of the loose body and internal fixation of the fragment using k wire or screw. We successfully managed an adolescent with a loose OCD fragment with an arthroscopic evaluation, removal of the loose body and refixation of the loose fragment to the parent location, using three bio screws.

4.
J Orthop Case Rep ; 9(2): 45-47, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31534933

RESUMO

Introduction: Heterotopic ossification of tendo Achilles (HOTA) is an uncommon clinical condition with unknown etiology. However, there are noted factors associated with this condition including trauma, metabolic conditions, infections, and genetic predisposition. The diagnosis can be made clinically and radiologically. We are reporting a rare case of HOTA managed surgically. Case Report: A 48-year-old healthy man with no history of trauma presented with pains and swelling of the posterior aspect of the left ankle and lower calf. The local examination revealed mass about 2 inches above the left ankle. A plain radiograph revealed a bony mass at the left TA region. The magnetic resonance imaging confirmed the presence of a bony mass within the substance of TA. All the clinical and biochemical laboratory tests were within normal limits. The heterotopic bone mass was removed, using a posterior longitudinal incision over the left TA, centering over the bony mass. At 6 months of follow-up, the patient had no pain, swelling, and a full range of ankle movements. Conclusion: Conservative approach may suffice in most of the patients while surgery is reserved for failed conservative treatment.

5.
J Clin Orthop Trauma ; 10(4): 835, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31528052

RESUMO

[This corrects the article DOI: 10.1016/j.jcot.2015.11.003.].

6.
J Clin Orthop Trauma ; 10(3): 535-540, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31061585

RESUMO

Background: Radial nerve is commonly injured with a fracture of the shaft of the humerus. Primary radial nerve injury occurs at the time of fracture, and secondary nerve injuries are seen after closed reduction or operative management. Management of these secondary nerve injuries is controversial regarding conservative approach verses early exploration. Materials and methods: The PubMed, Science Direct, Scopus, and Google Scholar were used to find out relevant studies in the English language from October 2007 to October 2017. After a search of total 114 articles, we excluded 107 articles which did not meet our inclusion criteria, and only seven studies were thoroughly reviewed. Results: Among the seven studies, three studies by Wang JP, Wang X, and Reichert P have included only secondary radial nerve injuries. Studies by Noaman H, Gouse M, Schwab TR and Bhardwaj A have included both primary as well as secondary radial nerve injury cases. Four studies used a conservative strategy and late exploration was advocated only if no nerve recovery was found within three to five months. Three studies recommended early radial nerve exploration (within the first two weeks) in patients with secondary radial nerve injury. Conclusions: The pattern and duration of radial nerve recovery in secondary nerve injury was similar to that seen in primary radial nerve palsy. No advantage was seen in the early exploration of the radial nerve in most of these studies. If there is no misplaced instrumentation, macroscopic laceration of nerve or fracture displacement in the postoperative radiograph, secondary radial nerve injury can be treated as a primary radial nerve injury, and we recommend observation for a minimum of four to five months before exploration.

7.
J Clin Orthop Trauma ; 10(3): 576-580, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31061593

RESUMO

Bilateral ACL rupture is a relatively uncommon injury with an incidence of 2-4%. Most bilateral ACL rupture occurs at two different times, but few cases of single-staged bilateral ACL ruptures have also been reported. There have been reports of both single-staged, and two-staged reconstruction of bilateral ACL ruptures in the literature but without a clear consensus. We present a series of five bilateral ACL rupture cases managed by single-staged arthroscopic ACL reconstruction, using quadrupled hamstring grafts. All of them were young males, with an average age of 26.8 years (Range: 19-39 years). Three out of five of these cases (60%) had sustained the injury to both the knees simultaneously while playing sports. All the five patients had generalized joint laxity with significant hyperextension of their knees. All the ten knees (in five patients) were clinically stable, at their last follow-ups. None of the knees had any early or late complications. A single-staged bilateral ACL reconstruction is a safe, reproducible, and cost-effective procedure for patients with a bilateral ACL deficient knee, in experienced hands.

8.
J Clin Orthop Trauma ; 10(1): 9-15, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30705525

RESUMO

Objectives: Vitamin D has been believed to have a bearing in the pathogenesis of knee osteoarthritis (OA). This study was done to search the literature and review the correlation between vitamin D levels in knee OA in the adult population and the outcome of vitamin D supplementation in knee OA. Methods: An exhaustive search of Pub Med and Cochrane library database was done with keywords vitamin D, knee and osteoarthritis for a period from Jan 2005 to December 2015. All Randomized Control Trials (RCT), Cohort, Case-control, cross-sectional studies were included in the present systematic review. Results: The search resulted in a total of 86 studies; out of which 11 studies were included in the current review. There were two Randomized Control Trial (RCT), one case-control, four cross-sectional and four cohort studies. These studies comprised of a total of 5137 participants (ranging from 46 to 1248) Our results suggested there was a moderate evidence of positive association in vitamin D deficiency (VDD) and progression of radiographic OA (ROA), as assessed by Kellgren and Lawrence (KL) grading. However, VDD was not associated with the incidence of ROA and MRI-detected change in focal cartilage defect. However, this study has a limited evidence for a positive correlation in VDD and the cartilage volume loss. There was also limited evidence showing no role of vitamin D therapy in reducing cartilage volume loss and knee pain in Knee OA. Conclusion: The VDD is common and has been associated with knee OA, in an adult population. However, there is still inconsistent evidence regarding the prevention of incidence and progression of ROA after vitamin D therapy. There is a need for multicentric and well-conducted randomized studies with larger samples to conclude the positive effect of Vitamin D therapy.

9.
J Clin Orthop Trauma ; 9(4): 300-306, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30449975

RESUMO

A medial open wedge high tibial osteotomy (MOWHTO) is an effective surgical procedure to correct varus deformity related to Knee Osteoarthritis. It consistently provides relief in knee pain and improves knee function. This technique is recommended for active, middle and old aged individuals with an isolated medial compartment knee OA. The MOWHTO scores several advantages over lateral closed wedge osteotomy and hence is now a preferred choice of HTO.

10.
J Clin Orthop Trauma ; 9(4): 327-333, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30449980

RESUMO

Introduction: Genu valgum is an angular deformity of the knee, often treated surgically by osteotomy or by growth modulation (using tension band, staples, transphyseal screws and eight-plate which require removal after correction). With this study, we attempt to evaluate the efficacy, rate of correction and complications with the use of 8-plate in the correction of genu valgum deformity in children. Material and method: In a retrospective study of 24 patients with 11 bilateral and 13 unilateral (35 knees) genu valgum deformity which required surgical corrections were included. There were 11 males, and 13 females and all of them were treated with Steven's technique (Stevens, 2006) using eight-plate and monitored closely. Result: Twenty-four patients with an average age of 10 years and 8 months (range: 5 yrs, 7 months-14 yrs, 2 months), with the mean preoperative & post-implant removal (Post-IR) tibiofemoral angle of 22.02° ± 5.15° (range 14°-31°) & 6.14° ± 1.92° (range 2°-10°) respectively, required an average time period of 1yr & 5m ± 5 m (range 10 months-28 months) for correction after which implants were removed. Of the 35 limbs, we achieved excellent results in 91.6%. One case (4.16%) had a partial correction of the deformity, and one case (4.16%) had reported with a superficial infection which was taken care. There were 2 cases (8.33%) of over-correction, which was gradually self-corrected during follow-up. Conclusion: Our results reflect the efficacy of flexible titanium eight plate which corrects angular deformity by acting as a tension band on one side of the growth plate and offers the advantage of reversible Hemi epiphyseal growth modulation. Guided growth modulation is a best available alternative for the treatment of an angular deformity in the patients with open physis.

11.
J Clin Orthop Trauma ; 9(4): 338-348, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30449982

RESUMO

Knee Osteoarthritis (OA) is a progressive degenerative joint disease affecting the quality of life of the elderly population. There is considerable evidence that nutraceuticals from natural herbs may play a significant role in inflammation and joint destruction in OA. We review the current status of some of the commonly used nutraceuticals in Indian market - Boswellia, Aflapin, Chondroitin sulphate, Glucosamine sulphate, Collagen peptide, Curcumin, Fish Oil, Ginger, Green tea, and Rosehip extract. We have summarized their mechanism of action, biological effects, toxicities and efficacy in the management of Knee OA. These supplements have been found to be effective in knee OA in various studies. No serious side effects have been reported for any of these supplements. Overall, our study identifies and support the use of these nutraceuticals to provide symptomatic relief to patients with knee OA and justify their use as an adjunct therapy for the management. More good quality trials are needed to provide definitive answers to questions related to their efficacy and safety for OA prevention and treatment.

12.
J Clin Orthop Trauma ; 9(3): 194-201, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30202148

RESUMO

Purpose: Three dimensional (3D) printing, also called 'rapid prototyping' and 'additive manufacturing' is considered as a "second industrial revolution." With this rapidly emerging technology, CT or MR images are used for the creation of graspable objects from 3D reconstituted images. Patient-specific anatomical models can be, therefore, manufactured efficiently. These can enhance surgeon's understanding of their patients' patho-anatomy and also help in precise preoperative planning. The 3D printed patient-specific guides can also help in achieving accurate bony cuts, precise implant placement, and nice surgical results. Customized implants, casts, orthoses and prosthetics can be created to match an individual patient's anatomy. The 3D printing of individualized artificial cartilage scaffolds and 3D bioprinting are some other areas of growing interest. We aim to study the publication trends in 3D printing as applied to the field of orthopaedics. Materials and methods: A literature search was performed to extract all papers related to 3D printing applications in orthopaedics and allied sciences on the Pubmed, Web of Science and SCOPUS databases. Suitable keywords and boolean operators ("3D Printing" OR "3-dimensional printing" OR "3D printed" OR "additive manufacturing" OR "rapid prototyping") AND (''Orthopaedics" OR "Orthopaedics'') were used, in May 2018. Search was attempted in Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Database of Abstracts of Review of Effectiveness (DARE) databases, using keywords 3d printing orthopaedics. A similar search was repeated in pubmed and SCOPUS to get more specific papers.No limits were set on the period or evidence level, as 3D printing in orthopaedics is relatively new and evidence available is usually limited to low-level studies. Trends in a publication on these topics were analyzed, focussing on publications, type of research (basic science or clinical), type of publication, authors, institution, and country. Some citations received by these papers were also analyzed in SCOPUS and Web of Science. MS Excel (2008 - Mac version) and VOS Viewer1.6.8 (2018- Mac version) software were used to analyze the search results and for citation mapping respectively. We also identified top 10 most cited articles in the field. Results: An increasing trend in publications in 3D printing-related work in orthopedic surgery and related fields was observed in the recent past. A search on Pubmed using the above strategy revealed 389 documents. A similar search revealed 653 documents on SCOPUS, many (314) of which were from an engineering background and only 271 were related to medicine. No papers were found in the Cochrane database. Search on TRIP database revealed 195 papers. A similar search revealed 237 papers on orthopedic applications on Pubmed and 269 documents on SCOPUS, whereas a search on Web of Science revealed only 23 papers. Publication trends were then analyzed on data derived from SCOPUS database. Overall, most papers were published from China, followed by United States, United Kingdom, and India. Conclusion: There has been an upsurge of interest in 3D printing in orthopedic surgery, as is evident by an increasing trend in research and publications in this area in the recent years. Presently, 3D printing is in a primitive stage in the field of orthopedic surgery as our knowledge is still insufficient, and costs and learning curve are somewhat high. However, looking at latest publication trends, we are enthusiastic that it holds the key to future in orthopaedics and trauma cases.

13.
J Clin Orthop Trauma ; 9(3): 254-259, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30202158

RESUMO

Objectives: 3D printing is an emerging technology and its use in orthopaedics is being explored. We discuss the role of computed tomography based 3D printed patient specific jigs in total knee replacement. We also discuss the various advantages of 3D printed patient specific jigs and the future scope of their use in total knee replacement. Methods: A search of English literature was done and articles discussing the role of CT scan based 3D printed patient specific jigs in total knee replacement were included in the study. Results: The role of 3D printed jigs in total knee replacement have been found in the prediction of femoral valgus angle, component sizing and in retained hardware. They have shown promise with studies suggesting they might improve the overall mechanical alignment of the knee. There are studies which have also studied the combined role of patient specific instruments with navigation. Conclusion: 3D printed jigs hold promise in total knee replacement. Their use in total knee replacement in the presence of retained hardware is useful for the surgeon. They have also showed promise in improving prediction of component sizing and improving mechanical alignment of the knee. Further studies with longer follow up and larger sample size will help in establishing their role in total knee replacement.

16.
J Clin Orthop Trauma ; 9(2): 107-111, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29896010

RESUMO

Introduction: Considering the old age, uncertain life expectancy, co-morbidities and fear of postoperative complications, elderly patients often hesitate to undergo simultaneous bilateral total knee arthroplasty (SBTKA). Materials & methods: A retrospective study of SBTKA in 46 patients (92 knees) of age >70 years done between 2003 and 2012. Mean age was 80.13 ± 5.24 years (range -70-93 years). Results: 74 percent had 1 or more major medical problems. There was a significant improvement of KSS at six months (p value = 0.00). Conclusion: With expected benefits of surgery, SBTKA seems a safe, efficient, and viable procedure for carefully selected elderly patients.

17.
J Clin Orthop Trauma ; 9(2): 112-115, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29896011

RESUMO

Purpose: We undertook this study to determine whether it is justifiable to use a fixed femoral valgus angle in patients undergoing TKR. Method: 134 knees (59 females and 19 males) were studied by measuring their femoral valgus angle (FVA) on CT scan and the data was assessed statistically. Result: The average FVA was 5.83° ± 0.64 (range - 4-7.5°). There was no statistically significant difference (p > 0.05) between the FVA between males and females and as per age. Conclusion: We conclude that it is justifiable to use a fixed femoral valgus cutting angle in the patients undergoing total knee replacement.

18.
J Orthop Case Rep ; 8(1): 89-92, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29854703

RESUMO

Introduction: Stress fractures occur due to abnormal increased or repetitive stress on a normal bone. These have been described in sports persons or military personnel involved in strenuous physical activities. Stress fractures occurring as a result of undue stress due to deviated mechanical axis usually involve the proximal tibia and fibula and have rarely been described in the literature. Case Report: We report a case of the left medial malleolus stress fracture secondary to advanced knee osteoarthritis (OA) with severe varus deformities. Mechanical malalignment like severe genu varus deformity is a risk factor for a stress fracture in knee OA. A single-staged management by the surgical treatment of stress fracture, along with the correction of underlying knee deformity by bilateral simultaneous total knee arthroplasty of this case is discussed. We also describe the pathomechanics involved in this injury in the present case report. Conclusion: Stress fractures associated with knee OA can be found in the ankle as well. Detailed history and clinical examination can help in diagnosing this condition. It is also important to correct the overall mechanical alignment of the knee to provide an adequate environment for fracture healing.

19.
J Clin Orthop Trauma ; 9(1): 34-39, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29628681

RESUMO

Background: The purpose of the study was to assess the accuracy of tibial and femoral component size prediction using computerised tomography (CT) based patient specific instruments in total knee arthroplasty. Methods: Eighty-eight knees in 58 patients underwent total knee arthroplasty (TKA) using CT based patient specific instruments between March 2015 to April 2016. All patients were assessed for the pre operative femoral and tibial component sizes predicted by the CT-based pre-operative plan. These sizes were compared with the actually implanted sizes during surgery, and the results were assessed. The data were evaluated using Wilcoxon signed rank tests, and p value set at <0.05 for significance. Results: Approximately 72% predicted tibia sizes matched the final implanted sizes whereas 66% femoral implants matched their pre-operative predicted sizes. The difference in the tibial implant size was not statistically significant (p-value > 0.05). However, the difference in the femoral size was statistically significant (p-value 0.009). The downsizing of the tibial component was needed in 14.8% knees whereas upsizing was required in 13.6% of the knees. At the femoral side, 22.7% components required downsizing at the time of implantation as compared to 11.4% components wherein a bigger component was used. Conclusions: We conclude that size prediction using CT-based technology for patient specific instrumentation is not fool proof. The size prediction accuracy for femoral and tibial components at 66% and 72% are low and cannot be relied upon at present. The patient specific technology using CT scan based jigs holds promise for the future, needs refining and fine tuning.

20.
J Clin Orthop Trauma ; 9(1): 46-50, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29628683

RESUMO

Introduction: A tourniquet is used during the total knee replacement surgery to improve the visibility, to reduce the blood loss and for better cementation. Indirectly it decreases the duration of surgery and enhances the recovery of the patient. Their use however is controversial due to some side effects associated with the use of tourniquet. They may increase the risk of deep vein thrombosis and pulmonary embolism by causing venous stasis, endothelial damage and increased platelet adhesion secondary to distal limb ischemia. Material and Methods: We conducted a randomized controlled trial (RCT) to examine the benefits and risks associated with the use of long duration over short duration tourniquets during TKA. The study was a prospective randomised control trial with a total of 80 knees (40 knees in each group) included in the study. The knees selected for surgery were randomly allocated to one of the two groups: Group A - long duration tourniquet (LT-group) or Group B - short duration tourniquet (ST-group). Result: The average operating time in Group A (43.53±3.11 minutes) was statistically less significant than that of Group B (51.7±2.56 minutes). Intra-operative blood loss in Group B, was significantly more than that of Group A. Post-operative blood loss in the drain was more in long duration tourniquet group. Total blood loss (intra-operative + post-operative) was more in short duration tourniquet group. Pain score (using VAS scale) was comparable in both the groups at the end of the second and sixth week. At sixth weeks there was no significant difference in the range of motion in both the groups. The KSS score was not significantly different in both the groups in post operative period at first, second, and six weeks. There were no events of thrombo-embolism and deep vein thrombosis in either groups. In 11 patients (27.5%) of long duration tourniquet group, swelling, and redness of knee was seen post operatively as compared to three patients (7.5%) of short duration tourniquet group. Conclusion: The use of a short duration tourniquet during TKA gives better symptomatic pain relief in the early postoperative period as compared to long duration use of tourniquet. However, this is associated with increased blood loss, more operating time and not having a clear operative field. We suggest that a rational thinking and reconsidering the practice of routine use of long duration tourniquet in each and every case of TKA is required.

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