Orthopaedic Journal of M. P. Chapter

What is new in Orthopaedics?

Vivek Singh — 2024-07-22

New technology in orthopedics, leading to innovative solutions and improved patient outcomes. Various cutting-edge technologies are revolutionizing orthopedic surgery ie. Smart Implants and Wearable Technology, 3D printing, telehealth, Artificial Intelligence, Digital Templating, Online-based Orthopedic Visits, Picture Archiving and Communication System (PACS), Computer-Assisted Surgery (CAS), Deep Learning and Generative AI, big data, Augmented Reality, ambulatory surgery centers (ASCs), Virtual Care Technology, robotics, Biological Treatments and Patient-Specific Implants.

Problems Encountered in Uncemented THR in AVN of Hip Patients

Singh V — 2024-06-30

Background: Avascular necrosis of femoral head is a common problem. It mostly affects the femoral head (hip joint). Its management can be conservative or invasive. Total hip arthroplasty is the treatment of choice for third and fourth stage avascular necrosis. Problems and complications are associated with every surgery. Here, we will see the common problems and complications encountered in uncemented total hip replacement in avascular necrosis of hip patients.

Material and Method: Fifty patients of Avascular necrosis of femoral head of stage III and IV are operated in last three years by uncemented total hip arthroplasty and their results were assessed by Harris hip score. There are some problems which we encountered in preoperative, intraoperative and post operative period. Their assessment and solution are done in this study.

Results: The mean Harris hip score during preoperative stage was 52 and during postoperative stage was 94. Excellent results are seen in 43 patients, good results are seen in 6 patients and poor results are seen in one patient. Preoperative problems like protrusio acetabuli was seen in 5 hips and fixed flexion deformity is seen two patients. Intraoperative problem like periprosthetic fracture was seen in one patient. Postoperative complication like limb length discrepancy was seen in 6 patients, foot drop in one patient, posterior dislocation of hip in one patient, superficial infection in 3 patients, deep infection in one patient and periprosthetic fracture in one patient.

Conclusion: Problems and complications are the part and parcel of any surgery. we should not get panic and try to treat the problems and complications encountered in uncemented THR. If, properly treated any problem of the uncemented THR can be managed. Long learning curve and lot of patience is required to produce long term good results in uncemented THR in AVN of hip patients.

Missed Monteggia fracture in children - case series

Ajay Khare — 2024-06-30

Background: Missed Monteggia fractures in children may cause pain, deformity, decreased range of motion, and neurological symptoms. Various surgical techniques have been advised to reconstruct long-standing Monteggia injuries to get long-term upper limb function. The purpose of this study was to assess the clinical and radiographic results of surgical technique for missed Monteggia fracture-dislocations.

Material and method: A prospective evaluation of 5 patients who underwent surgical reconstruction of missed Monteggia fracture-dislocations was performed. The median patient age at the time of surgery was 10 years, and the median time from injury to surgery was 13 weeks. Median clinical and radiographic follow-up was one year.

Results: The median elbow range of motion improved from 90 degrees of flexion and 5 degrees short of full extension preoperatively to 120 degrees of flexion and full extension postoperatively. Forearm range of motion also improved from a median of 80 degrees of pronation and 60 degrees of supination preoperatively to 80 degrees of pronation and 80 degrees of supination postoperatively. Congruent radiocapitellar alignment was maintained in 4 patients. One patient had redislocation of the radiocapitellar joint, and 1 patients had radiographic re-subluxation. One of the 5 patients who experienced redislocation underwent early revision and achieved uncomplicated long term result.

Conclusion: Good improvements in elbow motion and radiocapitellar stability can be safely achieved in the majority of children following surgical reconstruction of missed Monteggia lesions.

Functional outcome of elastic nail fixation for Intertrochanteric fracture in medically high-risk elderly

Tirkey R — 2024-06-30

Introduction: Intertrochanteric fractures in elderly population are major health problem. There are so many implants available to treat these fractures. We used enders nail for intertrochanteric fractures in medically compromised and high-risk patients.

Material and method: Twenty-seven patients of intertrochanteric fractures of femur were operated by condylocephalic ender’s nail. We included elderly patient with age more than 60 year with high risk and medically compromised conditions. The clinical and radiographically assessment was done in all cases at 4-week, 6-week, 12 week and 6 months.

Results: Fracture healing was achieved in average 12.5 week (ranging from 10 week to 24 week). The mean Harris score was 82.

Conclusion: Our experience suggests that the chief indication of enders’ nail fixation is in the treatment of intertrochanteric femur fracture in critically ill patient who cannot tolerate anaesthesia for an hour and more. Ender’s nailing appears the least traumatic form of internal fixation.

A case series on floating knee injuries with ipsilateral femur and tibia fracture

Vivek Singh — 2024-06-30

Background: The floating injuries occur due to high velocity trauma following motor vehicle accidents. Management of such complex injuries is a challenging task even in experienced hands as there are no standard treatment guidelines. All the patient were first stabilized initially by external fixator and subsequently taken up for definitive surgery. Early fixation and aggressive mobilization ensure fracture union and leads to fewer complications.

Material and method: In this study, 10 cases of fracture ipsilateral femur and tibia were operated in R.D. Gardi Medical College, Ujjain between February 2022 to February 2024 with the sequence of early fixation by application of external fixator on the day of admission, followed by delayed definitive surgery through ORIF with plate osteosynthesis or CRIF with intermedullary nail as needed according to the fracture. This study incorporates all fractures associated with floating knee viz, fracture shaft femur, fracture distal femur (intra/extra articular), fracture proximal tibia with diaphyseal extension and fracture shaft tibia, also includes compound, comminuted fractures.

Results: With the surgical management protocol followed by us, union was achieved in all the 10 cases. Post operative infections was observed in 1 patient out of 10 and knee stiffness was noted in about 3 patients. The present study had a minimum follow up of 6 months.

Conclusion: The surgical management protocol implemented yielded outstanding functional and radiological outcomes across all cases. Patients demonstrated a remarkable ability to resume their pre-injury functional activities and achieved full weight-bearing walking without assistance within six months post-surgery.

Lateral Extra articular Tenodesis (L.E.T.) to control Anterolateral instability associated with ACL (Anterior cruciate ligament) deficient knees– A Novel study

Ashish Dubey — 2024-06-30

Introduction: Chronic ACL laxity, in particular Rotational laxity associated with an explosive pivot shift test, has being tend to cause combined damage to ACL and Anterolateral structures of knee. We, hereby present a study of adding a LET procedure to such Anterolateral Rotational instability.

Material and methods: We operated 8 cases (All males) with complete ACL tear with Anterolateral instability (7 patients with Grade 2 Pivot shift test,1 with Chronic ACL injury) from May 2020 to October 2021.We did primary ACL reconstruction in all knees, with adding LET procedure (Modified Lemaire’s technique).

Results: All patients were followed up for period of 6 months to 1 year (Average 8.6 months). A pre & Postoperative outcome scores were assessed by Lachman test, Pivot shift test (-ve in all, in post-op follow-up), Lysholm score (mean 90.75, %,) and Tegner score (average Gr 4).

Conclusion: After this study we can conclude that adding a LET procedure (Modified Lemaire’s technique) to an ACL deficient knee with Anterolateral instability (like explosive Pivot shift test), is beneficial as not only it reduces the Anterolateral instability but also, greatly reduces the risk of Graft Failure.

Hume fracture- Monteggia fracture variance- A case report

Vivek Singh — 2024-06-30

Background: The Hume fracture is an injury to elbow consist of fracture of the olecranon with associated anterior dislocation of the radial head which occurs in children. It’s a variance of Monteggia fracture.

Material and method: We hereby presenting a rare case of Hume fracture in a 9-year-old girl treated by open reduction and internal fixation by tension band wiring and olecranon shortening.

Results: At 5 months follow up patient is having 90 degree of flexion and 120 degrees of extension from completely extended elbow.

Conclusion: Hume fracture is a rare variance of chronic Monteggia fracture dislocation. Results are good, if treated properly.