Orthopaedic Journal of M. P. Chapter

Artificial Intelligence and Robotic surgery in Orthopaedics

Vivek Singh — 2024-03-04

Artificial intelligence (AI), first proposed by Prof. John McCarthy in 1956, aims to reproduce human intelligence using computers. Machine learning (ML) is a form of AI that uses computational algorithms that learn and improve with experience.[1] Artificial intelligence is improving the surgical skills of orthopaedic surgeons by improving their clinical decisions. Technology can improve the surgical skills of the doctors. It can also improve the healthcare system. By this, the computer uses neural networks and learning models to learn to distinguish patterns directly from data and learns on its own to select features to classify the input data. To put it simply, using AI and machine learning algorithms, the surgeon can make good use of a huge amount of data. This allows them to comprehend, predict, act, and learn. (2)

Pauwels’ osteotomy in fracture neck of femur in type II and type III

Tirkey R — 2024-01-31

Background: Pauwels’ osteotomy is a promising procedure to treat non-union in fracture neck of femur of type II and type III, with good success rate.

Material and methods: This study is conducted in department of orthopaedics, Netaji Subhash Chandra Bose Medical College & Hospital, Jabalpur (M.P.) India from 1st December 2022 to 31st December 2023. This prospective study and functional analysis of Pauwel’s Osteotomy in fracture neck of femur in type II and type III was done on 10 patients.

Results: Out of 10, union was achieved in 8 patients and 2 patients were lost to follow up. Average time of union of fracture was 15 weeks. All the patients were able to squat, sit cross-legged and stand up on one leg.

Conclusion: Valgus osteotomy and fixation with dynamic hip screw has high success rate in young patients with neglected and ununited intracapsular fracture neck of femur as far as the union of fracture is concerned.

Functional and radiological outcome of long proximal femoral nail in subtrochanteric femur fracture

Singh V — 2024-01-31

Introduction: Treatment of subtrochanteric fracture is always a challenge for orthopaedic surgeons. Use of proximal femoral nail helps to prevent excessive fracture impaction and consecutive limb shortening in unstable intertrochanteric and subtrochanteric fractures. Our study is aimed to observe the results of Subtrochanteric fractures treated by Long Proximal Femoral Nail.

Material and Method: This observational study was conducted in Department of Orthopaedics of R D Gardi Medical College & associated CRGH, Ujjain during the year July 2016 to June 2018. In this study, 32 cases of fracture subtrochanteric femur (Seinsheimer type I, II, III, IV, V) were admitted and treated by internal fixation using long PFN.

Results: Out of these 32 cases, 1 patient expired and 1 patient was lost in follow up, so our study is aimed at remaining 30 cases. Results were assessed by Modified Harris Hip Score. Modified Harris Hip Score at final follow up (6 months) was Poor in 2 (6%) cases, Fair in 3 (10%) cases, Good in 11 (37%) cases and Excellent in 14 (47%) cases. Mean Modified Harris Hip Score was 87.16.

Conclusion: Our conclusion is that in subtrochanteric fracture, Long PFN helps in achieving good biological reduction, provides stability and prevents excessive collapse & limb shortening. Thus, it helps in achieving overall good functional outcome.

Supracutaneous LCP as a definite fixation method in compound metaphyseal and intraarticular fractures of tibia

Bajoria R S — 2024-01-31

Introduction: Open fractures of distal and proximal tibia are common injuries encountered by orthopedic surgeons. Metaphyseal compound fractures are not suitable for ORIF with greater chances of infection, soft tissue complications and risk of plate exposure. With external fixator, treatment & fracture healing period usually increased & complication rates are quite high, so we managed these fractures by supracutenous LCP as external fixator; and results evaluated. We find out it a better alternative method to conventional external fixator. We evaluated the feasibility of supracutenous LCP as definite fixation methods in open fractures.

Material and methods: This study conducted from April 2020 to October 2023. Total 30 cases were included in this study. Open GA II & IIIA of tibia metaphyseal fractures in 18 cases and intra articular tibia fractures in 12 cases included in this study. Debridement & LCP plates fixation was done in external fixator manner. Proximal & distal tibia LCP fixed with long screws. Most fixations were done within 1 - 5 days of trauma. Patients were followed up till bony union. Minimum follow up was 6 months.

Results: 8 cases united in 4 months, 8 cases united in 6 months, 9 cases united in 6-9 months and 5 cases went in non-union. Average duration of union was 5.6 months. Functional outcomes evaluated by AKSS score for proximal fractures & by AOFAS for distal fractures. 15 cases have shown excellent results; with union, 11 cases have shown good results; soft tissues reconstruction required, 4 cases had bad results; due to infection. Overall, 26 cases were had good to excellent results.

Conclusion: We observed that external fixation in open fractures usually results in infection, delayed or non-union, requirement of further surgeries. Supracutaneous LCP as primary definite fixation can give excellent results in terms of stable & rigid fixation, early fracture union, less chances of second surgery, cost effective and better patient compliance & better functional outcomes.

Core decompression and non-vascularized iliac crest graft in avascular necrosis of hip

Ajay Khare — 2024-01-31

Background: Avascular necrosis of femoral head occurs due to impaired blood supply of the head of femur. Core decompression with non-vascularized iliac crest graft has been the treatment of choice in cases of early AVN.

Material and Method: This prospective, interventional study was conducted in Global hospital, Ujjain from jan-2022 to march -2023. We studied 20 hips having AVN of the femoral head treated by core decompression and autologous cancellous bone grafting with a graft taken from the iliac crest. Total number of 20 patients with AVN of the femoral head (up to grade 2b of Ficat and Arlet classification) were treated by use of non-vascularized bone graft.

Results: The mean HHS was 69.45 preoperatively and 83.55 at six months postoperatively (p ≤ 0.0003). Out of 20 hips, 14 had excellent (HHS >90) to good (HHS 80-90) outcomes, while six had fair (HHS 70- 80) to poor (HHS >70) outcomes. The mean VAS score was 6.3 preoperatively and 3.8 at six months postoperatively (p ≤ 0.0001). On radiographic and clinical evaluation, the patients showed significant improvement on the six-month follow-up.

Conclusion: Our study suggests that core decompression with autologous cancellous bone grafting might not reverse AVN progression, but can delay the progression of AVN, avoid collapse, reduce pain, and provide improvement in functional outcomes at least in the short term.

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Comparative study between dynamic hip screw and trochanteric femoral nail in intertrochanteric femur fracture

Singh V, Nagle A, Patidar A, Jain A, Bhinde S, Agrawal A, Jain P, Soni A — 2024-01-31

Introduction: The incidence of intertrochanteric fracture has been rising with an aging population in many parts of the world and the number of hip fractures is expected to increase year after year. Reduction of fracture is the goal of treatment so that near anatomic alignment and normal femoral anteversion are obtained. Surgical treatment with stable reduction and fixation allows early mobilization and reduces complications. There are two main types of fixations for intertrochanteric fractures- the extramedullary plate fixation and intramedullary nail.

Aims and Objective: The main objective of this study was to compare outcome of Dynamic Hip Screw and Trochanchanteric Femoral Nail in patients of intertrochantric femur fracture.

Material and Methods: In this study, 50 patients of intertrochanteric fracture were admitted and randomly divided into two groups. 25 patients operated with Dynamic Hip Screw and other 25 were undergone Trochanteric Femoral Nail fixation. Outcome after the surgery such as average duration of surgery, blood loss, hospital stay and functional outcome were assessed using Harris Hip Score.

Results: The study findings reveal that there was a significant difference in mean operative time between both study groups with p<0.05. Hence in dynamic group mean operative time was 2.26±0.44 hours and in trochanteric femoral nailing mean operative time was 1.96±0.2 hours. Blood loss was more significant in patients with DHS as compared with TFN p<0.05. In dynamic group mean Harris score was 81.76±9.49 and in trochanteric femoral nailing mean Harris score was 87.12±7.74.

Conclusion: Surgical management of intertrochanteric fractures is the preferred treatment to avoid complications of prolonged immobilization. Dynamic Hip Screw (DHS) has been the gold standard. Our study indicates that TFN may be better choice when compared to DHS in unstable intertrochanteric fractures.

A rare case of popliteal pterygium syndrome

Hans A, Bajoria R S, Singhal V — 2024-01-31

Popliteal Pterygium Synrdome is an extremely rare genetic disorder which can present with multiple body anomalies, especially the musculoskeletal anomalies.

The very striking characteristic is presence of popliteal pterygium contracture; this connective tissue band can extend from ischial tuberosity to the calcaneum which can severely restrict range of motion, knee extension, abduction and rotation. This case report presents a case of 3-year-old girl child with significant unilateral deformity in left lower limb. Examination revealed extensive popliteal web/contracture left side with associated deformity at left ankle. Serial surgical correction was done with uniplanar ex fix (Distractor) application followed by Tendo Achillis tenotomy and serial splinting with regular follow-ups done. The child was treated successfully with satisfactory results.