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Journal of Clinical Orthopaedics and Trauma

Sandeep Dathik, Rajesh Kumar Chopra, Jatin Talwar, Mozammil Pheroz, Rajni Prasad
Hydatidosis is relatively uncommon entity and it rarely affects bone and joints. A rare case of primary hydatidosis (Echhinococcus granulosus infection) involving the distal femur and the knee joint in a 53 years old female is reported here. This presented as a pathological supracondylar fracture of femur. On establishment of a clinical diagnosis she was treated preoperatively with Albendazole 600 mg, daily for 3 cycles each of 21 days with a gap of 1 weeks between cycles. Two stage surgery was carried out, the first being a meticulous debridement and second a total knee replacement with cemented tumor mega-prosthesis...
January 2019: Journal of Clinical Orthopaedics and Trauma
Anil Agarwal, Nargesh Agrawal, Anurajan Dubey, Neeraj Gupta
Purpose: We measured the foot size and shoulder width in North Indian children with idiopathic clubfoot and calculated the corresponding metal rod length for abduction brace. The differences in the foot length in unaffected, unilateral and bilateral clubfeet were also measured. Patient and methods: Two sets of measurements were taken on each child: feet size and shoulder width. Using statistical analysis, the following were compared: Differences in the manual prescribed and our calculated SFAB bar length, foot size in unilateral clubfoot and unaffected foot and both feet in bilateral clubfoot...
January 2019: Journal of Clinical Orthopaedics and Trauma
Vivek Trikha, Sahil Gaba, Prabhat Agrawal, Saubhik Das, Arvind Kumar, Buddhadev Chowdhury
Objectives: The management of high energy tibial plateau fractures is a surgical challenge. Recently described Luo's classification is based on CT scans and is more objective with a better inter-observer agreement as compare to Schatzker and AO/OTA classifications. We describe the functional results of a series of 53 cases classified and managed according to the Luo's column concept. Methods: A retrospective review of 53 high energy tibial plateau fractures, operated between January 2012 and March 2015 at a Level I trauma center, was performed...
January 2019: Journal of Clinical Orthopaedics and Trauma
Towseef Ahmad Bhat, Rouf Ibrahim, Tariq Ahmad Bhat, Aejaz Ahmad Bhat
Background: Open fractures are still associated with troublesome rates of infection. Thorough debridement irrigation and antibiotic cover are of paramount importance irrespective of the fixation method. VAC therapy is a well known method of accelerating the wound healing and decreasing the infection in non healing ulcers. The main drawback of VAC therapy is requirement of a special equipment and high cost. We in our hospital are using low cost custom made VAC therapy for non healing ulcers in lower socio-economic people and have seen extremely good results in wound healing and infection control...
January 2019: Journal of Clinical Orthopaedics and Trauma
Pascal Chigblo, Iréti Fiacre Tidjani, Etienne Alagnidé, Eric Lawson, Soumaïla Madougou, Odry Agbessi, Aristote Hans-Moevi Akué
Background: Limb amputations are responsible for disability. We studied the outcomes of lower limb amputees in our daily practice. Methods: This prospective analytical study over 7 years (January 2009-December 2015) included 70 amputees of lower limb. They were mainly male (73%), aged on average of 42.4 ± 18.8 years. The mean time of follow- up was 3.2 ± 1.9 years. We assessed disability on balance, walking, disability in daily life for patients with prosthesis, and the socio-economic impact of the amputation...
January 2019: Journal of Clinical Orthopaedics and Trauma
Igor Kostic, Milan Mitkovic, Milorad Mitkovic
Background: The nonunion of open and closed tibial shaft fractures continues to be a common complication of fractures. Tibial nonunions constitute the majority of long bone nonunions seen by orthopaedic surgeons. In this article, we present our approach to the surgical treatment of noninfected tibial shaft nonunions. Methods: Between 2008 and 2014, 33 patients with aseptic diaphyseal tibial nonunion was treated by reamed intramedullary nailing and were retrospectively reviewed...
January 2019: Journal of Clinical Orthopaedics and Trauma
Alexis D Rounds, Karen E Burtt, Hyuma A Leland, Ram K Alluri, Ido Badash, Ketan M Patel, Joseph N Carey
Background: Lower extremity trauma accounts for over 300,000 injuries annually. While soft tissue transfer is a well-accepted practice for open fracture coverage, functional outcomes remain unclear. Hypothesis: This study investigates functional outcomes following soft tissue reconstruction for open tibial fractures. Materials and methods: A retrospective review of a prospectively maintained database of open tibia fractures requiring soft tissue reconstruction was performed at an urban level 1 trauma center between October 2013 and March 2015...
January 2019: Journal of Clinical Orthopaedics and Trauma
Annie C Weber, Michael G Hull, Aaron J Johnson, R Frank Henn
Background: Unstable ankle syndesmosis injuries are common, and the optimal surgical fixation is controversial. The two main options for stabilization of syndesmotic injuries are suture button fixation and screw fixation. Suture button fixation has a higher initial cost, but may have a lower hardware removal rate. The purpose of this study was to compare the costs of syndesmotic fixation. Methods: A cost analysis was performed at a single university-affiliated hospital...
January 2019: Journal of Clinical Orthopaedics and Trauma
Akshay Tiwari, Sandeep Mehta, S K Sharma, Vijaydeep Chauhan, Himanshu Rohela, Rajan Arora
Background: Reconstruction of segmental bone defects following resection of bone sarcomas is a challenging procedure. Vascularised fibula grafts alone or in combination with extracorporeal radiotherapy and reimplantation of tumor bone have long been established as a method of reconstruction of such defects, with satisfying results. Prompted by paucity of data on Indian patients, we report our experience with vascularised fibula graft for patients undergoing limb salvage surgery for sarcomas of bone...
January 2019: Journal of Clinical Orthopaedics and Trauma
Louis Gerber, Abdullah E Laher, Callistus O A Enyuma, Jared McDowall, Sunday J Aigbodion, Sean Buchanan, Ahmed Adam
Objectives: An incidental and sometimes humorous finding on an Antero-Posterior (AP) pelvis X-ray view is that of the John Thomas Sign (JTS), which is defined as positive, when the penile shadow points towards the side of a hip or pelvic fracture in male patients. Despite previous research reports and studies performed on the JTS sign, uncertainty with regards to its clinical relevance still remains. The objective of this review was to assess the clinical validity and accuracy of this sign by performing a systematic review and meta-analysis...
January 2019: Journal of Clinical Orthopaedics and Trauma
Vincenzo Giordano, Marcos Giordano, Renato Caravellos Glória, Felipe Serrão de Souza, Paulo di Tullio, Marco Martins Lages, Hilton Augusto Koch
Femoral head fractures occur almost exclusively as a result of a traumatic hip dislocation. Treatment is typically an emergency and includes the reduction of the dislocated hip under anesthesia. As a rule, the earlier the reduction, the better the outcome. Open reduction and internal fixation of the fracture of the femoral head is the treatment of choice for most young patients. In some selected cases when there is a very small fragment located in the region below the fovea, removal should be indicated. In elderly patients and those who experience severe femoral head impaction, it is preferable to perform a total hip replacement...
January 2019: Journal of Clinical Orthopaedics and Trauma
Rajeev Choudhary, Mudasir Malik, Ammar Aslam, Deepak Khurana, Sangita Chauhan
Background: The purpose of this study was to compare the values of quadriceps angle (Q angle) in relation to age, weight, height, gender, bilateral and postural variations, and strenuous activities on the weight bearing limbs in order to observe its variability. Materials and methods: A total of 450 adult healthy volunteers (150 male students, 150 female students and 150 male labourers) were enrolled in this cross sectional study. Each volunteer had its height, weight and Q angles measured...
January 2019: Journal of Clinical Orthopaedics and Trauma
Suprasanna K, Teja Chamala, Ashvini Kumar
Purpose: To compare the significance of the tibio-femoral geometrical indices (notch width index, medial and lateral tibial slopes) and patellar tendon- tibial shaft angle in predicting non-contact ACL injuries and to compare these factors between genders. Methods: Retrospective case control study evaluating 66 MRI knee of patients of age group of 18-60 years with 33 cases of noncontact ACL injury and 33 age matched controls. Notch width index, medial and lateral tibial slopes and patellar tendon tibial shaft angles were calculated and compared for statistical significance and was also compared between the genders...
January 2019: Journal of Clinical Orthopaedics and Trauma
Hardik Sheth, Abhijeet Ashok Salunke, Raghav Barve, Rajat Nirkhe
Introduction: The aim of the study was to evaluate the outcomes of Arthroscopic ACL Reconstruction using Fixed suspensory device and Adjustable suspensory device for femoral side graft fixation. Material and methods: We conducted a prospective study of sixty two patients with ACL deficient knees treated with arthroscopic ACL reconstruction. Consecutively patients were operated with fixed loop and adjustable loop suspensory devices for femoral side graft fixation and no randomization was done...
January 2019: Journal of Clinical Orthopaedics and Trauma
Manish Sharma, Prateek Behera, Ramesh Kumar Sen, Sameer Aggarwal, Sujit Kumar Tripathy, Mahesh Prakash, Gaurav Saini, Balaji Saibaba
Introduction: Total hip arthroplasty (THA) has been termed as 'operation of the century' as it provides a stable and mobile hip to patients who are debilitated by pathologies affecting the hip. Acetabular fractures pose a challenge for their initial management as well for the management of secondary osteoarthritis which is often the outcome of these fractures. The study attempts to evaluate the short term radiological, functional and quality of life outcomes of THA done in patients with prior acetabular fractures and to find a correlation between various factors...
January 2019: Journal of Clinical Orthopaedics and Trauma
Prasoon Kumar, Ramesh Sen, Sameer Aggarwal, Saurabh Agarwal, Rajesh Kumar Rajnish
Background: Standard Harris Hip Score (HHS) is a validated tool, to measure the functional status of an individual and has been traditionally used to assess the condition of a patient with hip pathologies. Harris hip score in its standard form includes a physician's physical examination component which has a high inter-observer variability. A modified version of HHS (MHHS) was devised and brought into use, but has not been validated as an outcome measure, post total hip replacement (THR) in Indian population...
January 2019: Journal of Clinical Orthopaedics and Trauma
Bradley W Wills, Jeffrey Pearson, Alan Hsu, Peng Li, Ashish Shah, Sameer Naranje
Background: Total hip arthroplasty (THA) is a very successful surgery in restoring a patient's quality of life. Infection is a devastating complication of THA. Many risks factors for infection in THA have been identified but little is known of the effect by preoperative hematocrit. Purpose: We aimed to evaluate the effect of preoperative hematocrit on early superficial site infections, deep infections, and deep organ space infections. Methods: Our study cohort included patients undergoing a THA in the ACS National Surgical Quality Improvement Program database from 2006 to 2015...
January 2019: Journal of Clinical Orthopaedics and Trauma
Chang Park, Adeel Ikram, Hani B Abdul-Jabar, Warwick J P Radford
Neuritis of the sciatic nerve is a rare complication of total hip replacements. It is characterized by symptoms of neuropathic pain with or without motor and or sensory symptoms. Causes include direct intra-operative trauma or mechanical lengthening of the nerve. Cases of sciatic nerve neuritis without an organic cause however, are rarer still. We present two cases of sciatic nerve neuritis post total hip replacement with no identified organic cause. Whereas the reversal of the underlying cause has shown improvement in symptoms, in cases without an organic cause our experience advocates close observation and conservative management with spontaneous resolution of symptoms...
January 2019: Journal of Clinical Orthopaedics and Trauma
R Thangaraj, William Wilson-Theaker, A Kumar, J Oakley
Background: Surgical techniques and instruments are continuously evolving to improve placement of components in ideal position. We investigated if there is difference in greater trochanter thickness between the stems in satisfactory position and stems in malposition and to assess the ideal thickness of trochanter for femoral stem placement in neutral position as under reaming of trochanter can result in stem malposition. Methods: Measurement of greater trochanteric thickness in 95 hip replacements (posterior approach) was performed by a junior doctor and two hip fellows using the trauma CAD/PACS software...
January 2019: Journal of Clinical Orthopaedics and Trauma
Sanjay Agarwala, Mayank Vijayvargiya
Objective: With the trend towards accelerated rehabilitation, the method of skin closure has become increasingly important in orthopedic surgery. It is imperative to evaluate a technique that provides superior clinical and cosmetic results specifically for TKA, due to relatively thin skin anterior to the knee making poor wound healing an issue of concern. We conducted a prospective, single-arm audit evaluating the patient assessments of incision cosmesis for a novel technique in TKA wound closure called Concealed Cosmetic Closure (CCC)...
January 2019: Journal of Clinical Orthopaedics and Trauma
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