Orthopedics
Amir Aghaei Aghdam; Ramin Askarinejad; Amin Jahad Sarvestani
Volume 10, Issue 1 , January 2024, , Pages 33-37
Abstract
Objective: Adult spinal deformity is a common public health issue worldwide caused by changes in the normal curves of the spine, at times leading to axial spine pain. This study measures changes in the normal curves of the spine, especially thoracic kyphosis and lumbar lordosis, and correlates them with ...
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Objective: Adult spinal deformity is a common public health issue worldwide caused by changes in the normal curves of the spine, at times leading to axial spine pain. This study measures changes in the normal curves of the spine, especially thoracic kyphosis and lumbar lordosis, and correlates them with subjective axial pain scores to find how anatomic changes in thoracic and lumbar curves relate to the subjective pain.Methods: This is a descriptive-analytical epidemiological study conducted in Ahvaz Golestan Hospital. In this study, 52 patients were selected by non-randomized convenience sampling of patients with axial spine pain referred to Golestan Hospital between October 2023 and June 2024. Thoracic kyphosis and lumbar lordosis were detected in the selected patients using long-standing radiographs. Then, using pelvic incidence, ΔTK and ΔLL were calculated, and their relation to axial spine pain was studied. We used the Pearson correlation coefficient to examine the relation between spine-related measurements and Visual Analogue Scale (VAS) scores. The distribution of the changes followed a normal distribution (Gaussian distribution) pattern, so Pearson correlation coefficient was employed.Results: On average, lumbar lordosis in these people showed a mean decrease of 10 degrees compared to normal lumbar lordosis, and average thoracic kyphosis showed a mean increase of 15 degrees compared to the normal thoracic kyphosis. In the study of the global pain scale and comparing the intensity of pain with changes in thoracic kyphosis (ΔTK) and lumbar lordosis (ΔLL), axial pain was most associated with changes in thoracic kyphosis (ΔTK) (P < 0.001).Conclusion: In the treatment of axial spine pain, the intensity of pain is more related to changes in thoracic kyphosis rather than lumbar lordosis. This can help researchers to propose further studies on correcting thoracic kyphosis to obtain better axial spine pain relief.
Orthopedics
Marcus vinicius Bianchi; Leonardo Comerlatto; Cristina Vicioli; Ramesses Akamefula; Marcio Balbinotti Ferrari
Volume 10, Issue 1 , January 2024, , Pages 74-76
Abstract
Objective: Quadriceps tendon ruptures are rare injuries affecting the knee extensor mechanism, typically occurring in middle-aged patients with underlying pathologies. Bilateral simultaneous quadriceps tendon ruptures are even more uncommon, and almost all reported cases in the literature are associated ...
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Objective: Quadriceps tendon ruptures are rare injuries affecting the knee extensor mechanism, typically occurring in middle-aged patients with underlying pathologies. Bilateral simultaneous quadriceps tendon ruptures are even more uncommon, and almost all reported cases in the literature are associated with an underlying disease.Case Presentation: A 62-year-old Caucasian male presented complaining of pain in the anterior-superior aspect of both knees following a fall while walking that same day, during which his knees were in a semi-flexed position. Physical examination revealed a loss of active knee extension in both limbs and a palpable gap between the superior pole of the patella and the quadriceps tendon. MRI of both knees was performed two days after the injury, confirming bilateral quadriceps tendon ruptures. Twelve days after the initial injury, the patient underwent surgical intervention, and both injuries were addressed simultaneously using a transosseous tunnel technique. The transosseous technique consisted of three longitudinal and parallel tunnels drilled into the patella, and a modified Kessler suture was used to secure and reattach the quadriceps tendon back to the superior pole of the patella. At the patient’s eight-month follow-up, the patient was asymptomatic, ambulating normally, and had full knee extension with 120° flexion bilaterally. However, hypotrophy of the quadriceps muscle was noted bilaterally.Conclusion: Proper evaluation and treatment of these injuries are crucial to achieving good outcomes, as they can lead to significant knee pain and disabilities.
Trauma
Smita Bhat; Amal Suresh; Apeksha Inamdar; Anil Kumar Desai; Gopal Krishnan
Volume 9, Issue 1 , January 2023, , Pages 52-53
Abstract
Objective: Fractures of orbital rims are common and restoration of these fractures back toits normal anatomic form is essential to maintain the function and aesthetics of the eyes.Low profile miniplates are the rigid fixation device of choice for such fractures. But in caseof sagittal and grossly displaced ...
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Objective: Fractures of orbital rims are common and restoration of these fractures back toits normal anatomic form is essential to maintain the function and aesthetics of the eyes.Low profile miniplates are the rigid fixation device of choice for such fractures. But in caseof sagittal and grossly displaced fractures of orbital rims it is difficult to achieve stability byusing miniplate osteosynthesis. The low profile miniplates may not be able to withstandthe forces to reduce this kind if grossly displaced fractures, another stable option needs tobe considered in these situations.Case presentation: This case report presents a simple and effective technique of reductionand fixation of an oblique fracture of infraorbital rim fracture using lag screw principle.A standard titanium screw of 2 mm diameter and 10 mm length is being used in thedescribed technique for stable fixation of fractured segments.Conclusion: The technique is simple, hardware’s are easily available and can be practisedin emergency circumstances where newer advanced technologies are not available
Infectious disease
Akash Singhal; Anil Kapoor
Volume 8, Issue 2 , July 2022, , Pages 86-87
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been universal and swift inits spread. As orthopaedic surgeons, for the most of us this timeframe has reduced ouractivity to emergency and trauma cases only, with virtual outpatient clinics and no electivesurgeries. With some of the common deformity ...
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The coronavirus disease 2019 (COVID-19) pandemic has been universal and swift inits spread. As orthopaedic surgeons, for the most of us this timeframe has reduced ouractivity to emergency and trauma cases only, with virtual outpatient clinics and no electivesurgeries. With some of the common deformity problems including clubfoot etc, whichcomprises a large number of children in the developing world, the management has beendeferred, without any regional and national guidelines being framed. Updated guidelinesrelating to the management of clubfoot patients, in which parents can safely consultwith the orthopaedic surgeon and physical rehabilitation specialists will allow them tocope with this unprecedented situation. We revisit the current scenario and the possiblemanagement protocol in the context of COVID-19 pandemic.
Orthopedics
Ganesh Singh Dharmshaktu; Tanuja Pangtey
Volume 8, Issue 2 , July 2022, , Pages 88-89
Abstract
A 52-year-old male presented with atraumatic left side calf swelling for the last three months. The swelling had acute onset and increased gradually in size. He had a history of rheumatoid arthritis with treatment options limited to physiotherapy sessions and pain medication as he could not continue ...
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A 52-year-old male presented with atraumatic left side calf swelling for the last three months. The swelling had acute onset and increased gradually in size. He had a history of rheumatoid arthritis with treatment options limited to physiotherapy sessions and pain medication as he could not continue disease modifying anti-rheumatic drugs regularly. There was no history of co-morbidities like hypertension, tuberculosis, diabetes mellitus or bleeding diathesis. He neglected the swelling initially due to mild pain and little impact on activities of daily living till swelling increased to be apparent.
Orthopedics
Atul Rai Sharma; Akash Singhal; Anurag Patil; Gladson David Masih
Volume 8, Issue 1 , January 2022, , Pages 66-68
Abstract
Objective: Distal radioulnar joint (DRUJ) subluxation with associated both bones forearm fracture is a rare clinical entity and is easily missed, leading to significant functional limitations.Case Presentation: A 28-year-old male fell on the outstretched hand and suffered left side both bones forearm ...
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Objective: Distal radioulnar joint (DRUJ) subluxation with associated both bones forearm fracture is a rare clinical entity and is easily missed, leading to significant functional limitations.Case Presentation: A 28-year-old male fell on the outstretched hand and suffered left side both bones forearm shaft fracture with ipsilateral DRUJ disruption. Operative intervention in the form of plating was done for both bones forearm shaft fracture and DRUJ was stabilised with one k wire and above elbow plaster splint in full supination was given for 6 weeks. At one-year follow-up, fracture was united and Disabilities of the Arm, Shoulder and Hand (DASH) score was 11.7, and he was well satisfied.Conclusion: DRUJ disruption should be carefully evaluated in all the patients with associated shaft fractures of radius and ulna. Timely diagnosis and optimal intervention may prevent any functional limitations.
Surgery
Mohit Kumar Arora; Ela Madaan; Rajnand Kumar
Volume 6, Issue 1 , January 2020, , Pages 47-49
Abstract
Objective: Patella is a sesamoid bone which develops in the quadriceps tendon. It is an uncommon site for neoplasms. The most common primary tumors which involve patella are benign. These include chondroblastoma, giant cell tumor (GCT) and aneurysmal bone cyst. Malignant lesions are less common in patella. ...
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Objective: Patella is a sesamoid bone which develops in the quadriceps tendon. It is an uncommon site for neoplasms. The most common primary tumors which involve patella are benign. These include chondroblastoma, giant cell tumor (GCT) and aneurysmal bone cyst. Malignant lesions are less common in patella. These encompass metastasis, osteosarcoma and hemangioendothelioma. The most common complaint in patients of GCT patella is anterior knee pain. Early diagnosis and optimal management are necessary for improving survival rate in these patients.Case Presentation: The authors present a case report of GCT of patella in a 16-year old child. Incisional biopsy was done to confirm the diagnosis. Further radiological examination showed that the tumor involved almost whole of the patella. Hence, surgical management in the form of patellectomy and extensor mechanism repair was done to improve the outcome of the disease. The patient did not have any clinical or radiological symptoms at the end of the final follow up of 22 months.Conclusion: Primary tumor of patella is a rare entity. Benign tumors like GCT present only with anterior knee pain and should be included in the differential diagnosis of anterior knee pain. MRI is useful to determine the extent of involvement of tumor in the patella. Treatment may vary from curettage and bone grafting to total patellectomy with extensor mechanism repair
Trauma
Ganesh Singh Dharmshaktu
Volume 3, Issue 2 , July 2017, , Pages 64-65
Abstract
Simultaneous combination of fracture of the lateral condyle and postero-medial elbow dislocation is a rare event and limited to few reports or case series in the literature. Rarity of the injury also necessitates judicious diagnosis and appropriate management to ensure optimal functional outcome. Various ...
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Simultaneous combination of fracture of the lateral condyle and postero-medial elbow dislocation is a rare event and limited to few reports or case series in the literature. Rarity of the injury also necessitates judicious diagnosis and appropriate management to ensure optimal functional outcome. Various authors have reported about the condition including the management which mostly includes surgical intervention. A report of one such injury pattern in an 8 years old male child with operative management and satisfactory outcome is presented to highlight the presence of this rare combination and adherence to standard treatment protocols to address them. The report is an addition to the limited resources available on similar fractures and highlights the importance of ruling out possible associated injuries in cases of elbow dislocations. A good fixation of lateral condyle fracture is instrumental to avoid late complications leading to poor functional outcome. The early and supervised rehabilitation also plays a role in ensuring successful return to activities of daily living.
Trauma
Gholamreza Faridaalaee; Bahman Naghipour; Sajjad Ahmadi; Seyed Hesam Rahmani
Volume 3, Issue 2 , July 2017, , Pages 68-70
Abstract
Carotid artery thrombosis and concomitant brain infarction after blunt trauma are rare conditions. We report a 34-year-old woman with multiple traumas due to pedestrian car accident. At the time of initial visiting, she was somnolent and her Glasgow coma scale (GCS) score was 14. Initial vital signs ...
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Carotid artery thrombosis and concomitant brain infarction after blunt trauma are rare conditions. We report a 34-year-old woman with multiple traumas due to pedestrian car accident. At the time of initial visiting, she was somnolent and her Glasgow coma scale (GCS) score was 14. Initial vital signs (V/S) and brain computed tomography (CT) scan were normal. One day after admission to the emergency observation unit, GCS improved to 15 but right-sided hemiparesis occurred. Magnetic resonance imaging (MRI) showed brain infarction and Doppler sonography indicated internal carotid artery thrombosis. She was admitted in the Neurosurgery ward and underwent anticoagulant therapy. With appropriate treatment, the patient’s condition improved after 5 days of admission and she was discharged on oral warfarin treatment and close follow up. Although there is no ideal treatment for traumatic internal carotid artery thrombosis, it seems that in most cases anticoagulation therapy is the preferred method of treatment but in some patients surgical or endovascular revascularization is indicated.
Orthopedics
Felice Mucilli; Pierpaolo Camplese; Guiseppe Cipollone; Decio Di Nuzzo; Luigi Guetti; Marco Perioletta; Mirko Barone
Volume 3, Issue 1 , January 2017, , Pages 11-17
Abstract
Objective: Thoracic trauma may be a life-threatening condition. Flail chest is a severe chest injury with high mortality rates. Surgery is not frequently performed and, in Literature, data are controversial. The authors report their experience in the treatment of flail chest by an extracortical internal-external ...
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Objective: Thoracic trauma may be a life-threatening condition. Flail chest is a severe chest injury with high mortality rates. Surgery is not frequently performed and, in Literature, data are controversial. The authors report their experience in the treatment of flail chest by an extracortical internal-external stabilization technique with Kirshner’s wires (K-wires).
Methods: From 2010 to 2015, 137 trauma patients (109 males and 28 females) with an average age of 58.89 ±19.74 years were observed. Seventeen (12.41%) patients presented a flail chest and of these, 13 (9.49%) with an anterior one. All flail chest patients underwent early chest wall surgical stabilization (within 48 hours from the injury).
Results: In the general population, an overall morbidity of 21.9% (n = 30 of 137) and a 30-day mortality rate of 5.1% (n = 7 of 137) were observed. By clustering the population according to the treatment (medical or interventional vs surgical), significant statistically differences between the two cohorts were found in morbidity (12.65% vs. 34.48%, P = 0.002) and mortality rates (1.28% vs. 10.34%, P = 0.017). In patients undergoing chest wall surgical stabilization, with an average Injury Severity Score of 28.3 ± 5.2 and Abbreviated Injury Score (AIS) of 8.4 ± 1.7, an overall morbidity rate of 52.9% (n = 9) and a mortality rate of 17.6% (n = 3) were found. Post-surgical device removal, in local anesthesia or mild sedation, was performed 42.8 ± 2.9 days after chest wall stabilization and no cases of wound infection, dislodgment of the wires or osteosynthesis failure were reported. Moreover, in these patients, an early postoperative improvement in pulmonary ventilation (ΔpaO2 and ΔpCO2: +9.49 and -5.05, respectively) was reported.
Conclusion: Surgical indication for the treatment of flail chest remains controversial and debated both due to an inadequate training and the absence of comparative prospective studies between various strategies. Our technique for the surgical treatment of the anterior flail chest seems to be anachronistic, but the aspects described, both in terms of technical features and of outcome and benefits (health, economic), allow to evaluate the effectiveness of this approach.