Orthopaedic Journal of M. P. Chapter https://ojmpc.com/index.php/ojmpc <p><img src="/public/site/images/admin/ojmpc-cover1.jpg"><br>P-ISSN: <a href="https://portal.issn.org/resource/ISSN/2320-6993">2320-6993</a> | E-ISSN: <a href="https://portal.issn.org/resource/ISSN/2582-7243">2582-7243</a></p> en-US editor@ojmpc.com (Dr. Vivek Singh) admin@ojmpc.com (Zuber Ansari) Thu, 30 Jun 2022 00:00:00 +0530 OJS http://blogs.law.harvard.edu/tech/rss 60 Orthopaedics Residency in Post Covid Era https://ojmpc.com/index.php/ojmpc/article/view/152 <p>The COVID-19 pandemic is not only affected medical fields but also has a great influential impact on surgical fields like orthopaedics, as routine outpatient care and elective surgeries were hampered. All routine orthopaedic surgeries were postponed /cancelled because of this pandemic. Orthopaedics practice and training has been changed in post covid era. Orthopaedics residents have faced lot of problems in covid time. Long exhaustive duties and lack of orthopaedics surgery in covid time affected residents. Out of three years of residency almost six to eight months are taken away by covid. They have been trained less in orthopaedics surgery as well as teaching is also got affected in covid era. Residents got less exposure to subspecialities like arthroplasty, arthroscopy and spine. They have worked with physicians in corona wards to fight against COVID along with their routine orthopaedic duties.</p> <p>In 98% of institutions, academic teaching like seminars, workshops, case presentations, journal club, and ward rounds discussion has stopped during pandemic to prevent overcrowding and to maintain social distancing as many were asymptomatic carriers.</p> <p>There may be long term consequences, as residency training is crucial period to develop surgical skills and knowledge and if this is not proper, it can affect future orthopaedic practice of candidate.</p> <p>Due to reduced volume of orthopaedic cases, several departments have adopted a “residency surge plan”, with a part of trainees committed to routine hospital duties and remaining quarantined at home or posted in COVID-19-dedicated wards. Disruption of orthopaedic residency routine, usually consisting of surgical training, inpatient and outpatient care, will likely have an enormous impact on resident education. This is particularly relevant when considering that surgical training is practical in nature and is normally delivered in a climate of increasing autonomy, responsibility and complexity. Therefore, preserving orthopaedic education integrity while safeguarding resident health is a priority. Orthopaedics residents have worked very hard in covid period. Their enormous efforts have saved many lives. Though they are not well trained to treat covid patients but their huge efforts helped hospitals to overcome shortage of doctors in covid times. Their teaching and orthopaedics work was affected. Neet pre pg exam postponement increased their first-year residency time to almost 2 years. Now, they are compensating their teaching, academic work, clinical and surgical work. It has affected them physically and mentally.</p> <p>Small teaching modules, online webinars, offline classes and dissertation teaching are methods which have improved academics and teaching of students. Teachers should also try to show leniency towards their thesis work and exams.</p> Dr Vivek Singh Copyright (c) https://ojmpc.com/index.php/ojmpc/article/view/152 Thu, 30 Jun 2022 00:00:00 +0530 Standard care of management in Orthopaedic patient during COVID 19 Pandemic: An Institution based guideline https://ojmpc.com/index.php/ojmpc/article/view/150 <p>SARS-CoV 2 pandemic has been spread around the world, the developing countries like India with enormous population, the health care system has been exhausted with patients. Social distancing, using three layered face mask, frequent use of sanitization is helpful preventing measure to spread of these deadly virus. There are no clear cut guidelines available in management of Orthopaedic patients till now. The disease and mortality burden will increase eventually without the effective vaccine and medications. With this ongoing pandemic managing elective orthopaedic surgeries and delayed trauma is a challenge. There should be effective protocol to manage emergency cases with optimum care and formulate standard postoperative rehabilitation strategy to deal with the situation. Orthopaedics training is also affected by this pandemic and that should be taken care of with appropriate measures. This article will help the surgeons and hospitals to formulate proper strategies in managing the patients and to face challenges presented in current pandemic situation. It will guide them to re-establish the orthopaedic care and to face future challenges.</p> Anson Albert Macwan, Nanda S N, Samant S, Gachhayat A, Patel E, Mohanty A Copyright (c) https://ojmpc.com/index.php/ojmpc/article/view/150 Fri, 01 Jul 2022 11:40:45 +0530 Primary cemented bipolar hemiarthroplasty in elderly unstable intertrochanteric fractures https://ojmpc.com/index.php/ojmpc/article/view/143 <p><strong>Background</strong>: The incidence of inter-trochanteric fractures of the femur is very high in the elderly population. (1) Anatomic restoration of the neck of femur, along with articular congruity is the goal of management.</p> <p><strong>Materials and Methods</strong>: Thirty patients with unstable Intertrochanteric fractures were operated by Bipolar Hemiarthroplasty. Follow-ups were taken at 2, 6, 10 and 16 weeks. Harris Hip Score and FIM score were assessed.</p> <p><strong>Results</strong>: Mean Harris Hip score achieved was 87 at 16 weeks and Mean FIM score achieved was 78.9 at 16 weeks indicating good functional outcomes. The outcome was excellent in 23.4%, Good in 63.3%, Fair in 10% and Poor in 3.3% as per HHS.</p> <p><strong>Conclusion</strong>: This procedure offered pain free mobile hip with early mobilization, easy rehabilitation and early return to functional level, when standard techniques were used.</p> Thora A, Arpit Maurya Copyright (c) https://ojmpc.com/index.php/ojmpc/article/view/143 Fri, 01 Jul 2022 11:42:53 +0530 Functional and radiological outcome of parallel plate technique in distal humerus fractures: a prospective study https://ojmpc.com/index.php/ojmpc/article/view/153 <p><strong>Background</strong>: Distal humerus fractures account for 2-6% of all fractures and 30% of all elbow fractures.These are difficult to treat because of their complex anatomy, metaphyseal comminution of fracture, subchondral bone and articular involvement with small fragments.</p> <p><strong>Aim</strong>: To study the results of intercondylar fracture distal end humerus treated with open reduction internal fixation with parallel plating technique in terms of final range of motion of elbow, union time and rate of complications.</p> <p><strong>Material and Methods</strong>: A total of 25 patients with distal humerus intercondylar fractures treated with parallel plating technique were included in this prospective randomised study. At each follow up patients were evaluated clinically and radiologically for union and outcomes were measured in terms of MAYO Elbow Performance Score(MEPS) consisting of pain intensity, range of motion, stability and function.</p> <p><strong>Results</strong>: Eight (32%) patients got excellent outcome, fourteen(56%) got good outcome and 3(12%) got poor outcomes and complications observed were infection, non union, hardware prominence and elbow stiffness.</p> <p><strong>Conclusion</strong>: Open reduction internal fixation(ORIF) with parallel plating technique can be a successful technique for fixation of distal humerus intercondylar fractures when its principles are strictly adhered to.</p> Singh V, Bhinde S, Patidar A, Agrawal A, Sharma S K Copyright (c) https://ojmpc.com/index.php/ojmpc/article/view/153 Thu, 30 Jun 2022 00:00:00 +0530 Graft Options for Anterior Cruciate Ligament Reconstruction-choose wisely https://ojmpc.com/index.php/ojmpc/article/view/149 <p><strong>Background</strong>: Anterior cruciate ligament (ACL) tear constitutes a major chunk of post-traumatic knee injury leading to long term functional knee impairment and reduced quality of life. Globally, an increase in the incidence of reconstructive procedures for the torn ACL have been reported with varying outcome. This has revolutionized the techniques primarily aimed at achieving a functionally stable knee joint and early return to their pre-injury level of activities.</p> <p><strong>Discussion</strong>: Among the various factors which have influenced the outcome of the ACL reconstruction (ACLR), the choice of graft is a highly studied and yet still exceedingly debated topic. A large number of studies comparing the various graft options in ACLR has been published throughout the years. The purpose of this comprehensive review is to summarize the most recent relevant literatures on ACL graft options, on-going research and to discuss whether one graft type demonstrates clinical superiority over the other.&nbsp;</p> <p><strong>Conclusion</strong>: Understanding the biomechanical characteristics of various grafts available for anterior cruciate ligament reconstruction would help the surgeons in thoughtful selection of the graft for each patient on an individual basis and facilitate a thorough discussion between the surgeon and the patient which is vital in decision making.</p> Sandeep Vijayan, Nikhil Hegde, Mahesh Kulkarni, Monappa Aroor, Vishweshwar Bhat, Sharath Rao Copyright (c) https://ojmpc.com/index.php/ojmpc/article/view/149 Fri, 01 Jul 2022 11:45:11 +0530 A retrospective analysis of return to sports after 9 months in athletes in cases of anterior cruciate ligament reconstruction https://ojmpc.com/index.php/ojmpc/article/view/151 <p><strong>Background</strong>: The anterior cruciate ligament (ACL) is responsible for maintaining stability of the knee joint, particularly in activities involving pivoting or kicking. The knee loses its stability if the ACL is ruptured and the joint may become more damaged over time. ACL reconstruction is the surgical treatment of choice. Aim of this study is to analyze the rate of return to sports after 9 months in cases of anterior cruciate ligament reconstruction.</p> <p><strong>Material &amp; Methods</strong>: All cases operated for ACL reconstruction between the year 2017- 2020 were studied .This group included 80 patients with traumatic twisting, pivoting injury while playing sports, diagnosed with ACl tear, with instability at the knee joint .Exclusion criteria included avulsion injuries, meniscus involvement, posterior collateral ligament involvement, collateral involvement and any fracture of either femur or tibia involvement. The Scoring system used is ACL RSI (anterior cruciate ligament return to sport and injury scale).</p> <p><strong>Results</strong>: Total eighty athletes were included in this study. There was no association of symmetrical muscle function or quadriceps strength .The patients with a lower ACL RSI (anterior cruciate ligament –return to sport and injury scale) score had a lower rate of return to sports after 9 months post ACL reconstruction as well as a higher rate of secondary ACL injury.</p> <p><strong>Conclusion</strong>: Athletes operated for ACL reconstruction showed a low rate of return to their sports after 9 months. One of the potential concerns was with returning to sports the re-injury rate to the reconstructed ACL or to the other structures (cartilage, menisci or other ligaments) (1-3). Approximately 1 in 4 patients who are 25 years of age or younger and return to high-risk sport after primary anterior cruciate ligament (ACL) reconstruction sustain a second ACL injury (4).</p> Dr.Rajendraprasad Butala, Kedar Parelkar, Dr.Anuragdeep Syal, Dr.Varun Chandiramani Copyright (c) https://ojmpc.com/index.php/ojmpc/article/view/151 Fri, 01 Jul 2022 11:46:12 +0530 Primary Osteoarthritis Knee: establishing its cause, pathogenesis and treatment -A Prospective Case-Control Study https://ojmpc.com/index.php/ojmpc/article/view/142 <p><strong>Background</strong>: The objectives of this analytical study were to compare two scores, Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), Euroqol Group Health Status Score through Visual Analog Scale (EQVAS); Deficient Full Flexion (DFF) and Deficient Full Extension of knee at the beginning and end-point in two, Trial (G1) and Control (G2) groups of Primary Osteoarthritis Knee patients.</p> <p><strong>Material and Methods</strong>: In this study total patients were 125, in G1 - 100 and in G2 – 25. G1 group received hypothesized treatment, contracture correction therapy (CCT) while G2 did no therapy. WOMAC determination done by the questionnaire; EQVAS by vertical-scale and deficiencies by goniometer at 0, 6, 12 and 24 weeks. The CCT consisted of eight body postures, aimed to provide passive flexion or passive extension.</p> <p><strong>Results</strong>: The CCT receiving was associated with recovery (P 0.00) while non-receiving with deterioration (P 0.00). In G1, WOMAC improved: 71.70 to 3.68 and EQVAS 22.25 to 91.55 (P 0.00). In G2, WOMAC deteriorated score worsened from 53.00 to 71.88 and EQVAS 58.60 to 11.96 (P 0.00). DFF and DFE showed coinciding changes.</p> <p><strong>Conclusion</strong>: The cause, pathogenesis and treatment are deficient full flexion/deficient full extension; capsular contracture formation and passive flexion or passive extension respectively.</p> Radha Charan Agrawal Copyright (c) https://ojmpc.com/index.php/ojmpc/article/view/142 Fri, 01 Jul 2022 11:47:41 +0530 Clinical and functional outcome of uncemented total hip replacement in patients with avascular necrosis of femoral head https://ojmpc.com/index.php/ojmpc/article/view/154 <p><strong>Background</strong>: Avascular necrosis of femoral head is a common problem. New cases are now a days diagnosed early and treated early, because of Ayushman bharat yojna. It mostly affects the femoral head (hip joint). Its management can be conservative or invasive. [1-4]. Total hip arthroplasty is the treatment of choice for third and fourth stage avascular necrosis [5-8].</p> <p><strong>Material &amp; Method</strong>: Fifty patients of Avascular necrosis of femoral head of stage III and IV are operated by uncemented total hip arthroplasty and their results were assessed by Harris hip score.</p> <p><strong>Results</strong>: The mean Harris hip score during preoperative stage was 33.27 and during postoperative stage was 91.60. Excellent results are seen in 44 patients, good results are seen in 6 patients, poor or very poor results are seen in none patients.</p> <p><strong>Conclusion</strong>: Current generation of uncemented implants provide satisfactory clinical and radiographic outcomes in intermediate duration of follow up in avn of hip.</p> Singh V, Bhinde S, Patidar A, Jain S, Sharma SK Copyright (c) https://ojmpc.com/index.php/ojmpc/article/view/154 Thu, 30 Jun 2022 00:00:00 +0530 Paediatric Tuberculous spinal abscess causing compression at the lumbar level https://ojmpc.com/index.php/ojmpc/article/view/155 <p>Incidence of paediatric spinal tuberculosis (TB) is increasing. Paediatric spinal TB is known to cause rapid bony destruction and deformity progression. We present a 4-year child with lumbar kyphotic deformity, progressive lower limb weakness and early bladder involvement. Imaging revealed near complete destruction and retropulsion of L4 vertebra with spine at risk signs. Posterior decompression, L1 to S1 fixation with pedicle screws and punching the remaining L4 body ventrally was performed. With aggressive post-operative physiotherapy and AKT patient recovered neurologically from Frankel C to Frankel E grade with complete radiological resolution of disease at final follow-up of 1 year. No further progression of deformity was observed at final follow-up.</p> Dr Rahul Mehta, Agrawal A, Singh V Copyright (c) https://ojmpc.com/index.php/ojmpc/article/view/155 Thu, 30 Jun 2022 00:00:00 +0530