Radial Nerve Palsy Following Hemiarthroplasty of Hip: A Case Report Implying the Importance of Perioperative Patient Positioning

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Volume 7 | Issue 1 | Jan – April 2019 | Page: 29-31| Nithin M, Shimna C S, Mani N J

Authors: Nithin M [1], Shimna C S [2], Mani N J [1].

[1] Department Of Orthopaedics Baby Memorial Hospital,calicut,kerala
[2] Department Of Physiology Government Medical College, Palakkad, Kerala.

Address of Correspondence
Dr. Nithin M,
Sindhooram, Rayonpuram Po Perumbavoor, Kerala-683543
Email: nithinm.tmc@gmail.com

Abstract

Introduction: OIntroduction: Peripheral nerve injury is a dreadfulpost operative complication which is a source of great distress to the patient and the surgeon. An upper limb neuropathy after a lower limb surgery is even worse and difficult to defend in medicolegal litigations as it is essentially avoidable. Radial Nerve Injury can happen due to mechanical compression between hard surgical table and proximal arm while the patient is in a lateral decubitus position. This report signifies the importance of patient positioning and prevention of pressure points peri operatively to reduce the risk of this mishap.
Case Report: A 68 year old female who underwent hemiarthroplasty of the left hip complained of numbness and weakness of the right hand and inability to hold objects. The procedure was done in right lateral decubitus position and it lasted for about 45 minutes. The patient and treatment team had a tough time in the initial post operative period as she was unable to feed herself, hold on to objects and walk with the support of a quadrangular walker due to the weakness of right hand. Splint, rehabilitative exercises and galvanic current stimulation were employed for her treatment.
Conclusion: Our case report stresses the importance of peri operative patient positioning and general awareness of potential complications that can happen which are preventable.
Keywords: Radial Nerve Palsy, Hemiarthroplasty, Lateral decubitus position.

References

1. Su EP. Post-surgical neuropathy after total hip arthroplasty: Causality and avoidance. Semin Arthroplast 2016;27:70-3.
2. Nercessian OA, Macaulay W, Stinchfield FE. Peripheral neuropathies following total hip arthroplasty. J Arthroplasty 1994;9:645-51.
3. Sawyer RJ, Richmond MN, Hickey JD, Jarrratt JA. Peripheral nerve injuries associated with anaesthesia. Anaesthesia 2000;55:980-91.
4. Kroll DA, Caplan RA, Posner K, Ward RJ, Cheney FW. Nerve injury associated with anesthesia. Anesthesiology 1990;73:202-7.
5. Farrell CM, Springer BD, Haidukewych GJ, Morrey BF. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg Am 2005;87:2619-25.
6. Lee HC, Kim HD, Park WK, Rhee HD, Kim KJ. Radial nerve paralysis due to kent retractor during upper abdominal operation. Yonsei Med J 2003;44:1106-9.
7. Lin CC, Jawan B, de Villa MV, Chen FC, Liu PP. Blood pressure cuff compression injury of the radial nerve. J Clin Anesth 2001;13:306-8.
8. Tuncali BE, Tuncali B, Kuvaki B, Cinar O, Doğan A, Elar Z, et al. Radial nerve injury after general anaesthesia in the lateral decubitus position. Anaesthesia 2005;60:602-4.

How to Cite this article: Nithin M, Shimna C S, Mani N J. Radial Nerve Palsy Following Hemiarthroplasty of Hip: A Case Report Implying the Importance of Perioperative Patient Positioning. J Kar Orth Assoc. Jan-April 2019; 7(1): 29-31.

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Lets take JKOA Ahead Together

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Volume 7 | Issue 1 | Jan – April 2019 | Page: 1| Anil K Bhat

Authors: Anil K Bhat [1].

[1] Department of Orthopedics, Kasturba Medical College,Manipal, India.

Address of Correspondence

Dr Anil K. Bhat

Professor and Head,

Department of Orthopedics, Kasturba Medical College, Manipal

Email: anilkbhat@yahoo.com

Lets take JKOA Ahead Together

Dear KOA Members & Readers,

Wishing you all a very Happy New Year. It gives me an immense pleasure to present the first issue of KOA Journal for the year 2019. I am also happy to inform that we had published two issues in the last year (January-April & May-August) and hope to publish three issues this year which will help in scaling up our indexation capacity by next year.
I would like to thank the KOA members for their support in submitting scientific articles which helped us in publishing these issues. The Index Copernicus indexing has been maintained for our journal and future indexing including DOAJ & PubMed would soon be a reality. I request all the members submitting their scientific work to align their manuscript in the format prescribed by the journal. Peer review and copy editing process takes a lot of time and hence, the authors are requested to send the required corrections on priority which will help us speed up the process of publication.
The growing insistence of publications and research by UGC, MCI and other regulatory authorities which also have become a criteria for promotion and incentives have fostered publications in predatory or fake journals. With India having 903 Universities and almost 4,000 colleges, the academic performance indicators introduced by many regularity bodies which has made research compulsory for teachers has resulted in large number of these faculty to take the easiest option which is publishing in predatory journals. India is now seen as one of the biggest global hubs for predatory publishing. This requires a word of caution to the younger generation and also for faculty and researchers to avoid publishing in such journals which ultimately leads to erosion of honesty and ethics in clinical practice. The readers should acquaint themselves about such journals and a starting point would be the Beall”s list of predatory journals and publishers (www.beallslist.weebly.com). This website shows the entire list of publishers and journals which are predatory in nature and which is updated from time to time. The efforts of Mr. Jeffrey Beall, an American library science Professor has resulted in drawing attention to the racket of such fake journals. . Our journey through the research pathway should be with utmost caution and we need to guide our students and faculty not to adopt such mal-practices in their professional life. The KOA journal is committed for its integrity and good practice. The Editorial team hopes to receive authentic scientific work for future publications from all our members and readers so as to keep the integrity of our journal at its highest level.

Thanking you all and wishing once again a very prosperous year ahead,

Dr. Anil K. Bhat

Chief Editor, Journal of KOA

How to Cite this article: Bhat AK. Lets Take JKOA Ahead Together. J Kar Orth Assoc. Jan-April 2019; 7(1): 1

                                       

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Distal Radioulnar Joint injuries: Surgical anatomy, physical examination, Imaging and principles of management

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Volume 7 | Issue 1 | Jan – April 2019 | Page: 2- 8 | Anil K Bhat, N R Fijad.

Authors: Anil K Bhat [1], N R Fijad [1].

[1] Department Of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India

Address of Correspondence
Dr. N R Fijad,
Department of Orthopedics,
Kasturba Medical College, Manipal, Karnataka, India
Email: drfijadnr@gmail.com

Abstract

The complex anatomy of distal radioulnar can make diagnosis of this joint problems challenging. Disorders of the DRUJ are a major source of ulnar-sided wrist pain. Stabilization of this joint is provided by both intrinsic and extrinsic stabilizers and the joint capsule. Several clinical tests have been suggested to determine static or dynamic DRUJ stability. Radiologic evaluation of DRUJ instability begins with conventional radiographs .CT-scan seems to be the best additional modality to evaluate the osseous structures. MRI has proven to be more sensitive and specific for TFCC tears, potentially causing DRUJ instability, while arthroscopy is the gold standard for evaluation. Symptomatic DRUJ injuries treatment can be conservative or operative. Operative treatment consist of restoration of osseous and ligamentous anatomy. Chronic instability requires reconstruction of the stabilizing ligaments to avoid onset of arthritis. Salvage procedures in arthritis is gaining acceptance in the management of arthritis. This review covers various problems affecting the distal radioulnar joint, including fractures and dislocations, triangular fibrocartilage pathology and arthritis.

Keywords: Cadaveric and CT scan study, DRUJ instability, Sigmoid notch morphology.

References

  1. Palmer AK, Werner FW. Biomechanics of the Distal Radioulnar Joint. Clinical Orthopaedics and Related Research. 1984; &NA;(187).
  2. Tolat AR, Sanderson PL, Smet LD, Stanley JK. The Gymnast’s Wrist: Acquired Positive Ulnar Variance Following Chronic Epiphyseal Injury. Journal of Hand Surgery. 1992;17(6):678–81.
  3. Tolat AR, Stanley JK, Trail IA. A Cadaveric Study of The Anatomy and Stability of The Distal Radioulnar Joint in The Coronal and Transverse Planes. Journal of Hand Surgery. 1996;21(5):587–94
  4. Tay SC, Tomita K, Berger RA. The “Ulnar Fovea Sign” for Defining Ulnar Wrist Pain: An Analysis of Sensitivity and Specificity. The Journal of Hand Surgery. 2007;32(4):438–44.
  5. Nakamura T, Yabe Y, Horiuchi Y. Functional Anatomy of The Triangular Fibrocartilage Complex. Journal of Hand Surgery. 1996;21(5):581–6.
  6. Seo KN, Park MJ, Kang HJ. Anatomic Reconstruction of the Distal Radioulnar Ligament for Posttraumatic Distal Radioulnar Joint Instability. Clinics in Orthopedic Surgery. 2009;1(3):138
  7. Nakamura R, Horii E, Imaeda T, Tsunoda K, Nakao E. Distal radioulnar joint subluxation and dislocation diagnosed by standard roentgenography. Skeletal Radiology. 1995;24(2).
  8. Lester B, Halbrecht J, Levy IM, Gaudinez R. “Press Test” for Office Diagnosis of Triangular Fibrocartilage Complex Tears of the Wrist. Annals of Plastic Surgery. 1995;35(1):41–5.
  9. Mino DE, Palmer AK, Levinsohn FM, Siverman PM. The Role Of Radiography And Computerized Tomography In The Diagnosis Of Subluxation And Dislocation Of The Distal Radioulnar Joint. Journal of Computer Assisted Tomography. 1983;7(6):1135.
  10. Freedman DM, Dowdle J, Glickel SZ, Singson R, Okezie T. Tomography Versus Computed Tomography for Assessing Step Off in Intraarticular Distal Radial Fractures. Clinical Orthopaedics and Related Research. 1999;361:199–204
  11. Anderson ML, Skinner JA, Felmlee JP, Berger RA, Amrami KK. Diagnostic Comparison of 1.5 Tesla and 3.0 Tesla Preoperative MRI of the Wrist in Patients with Ulnar-Sided Wrist Pain. The Journal of Hand Surgery. 2008; 33(7):1153–9.
  12. Kazemian GH, Bakhshi H, Lilley M, Moghaddam MET, Omidian MM, Safdari F, et al. DRUJ instability after distal radius fracture: A comparison between cases with and without ulnar styloid fracture. International Journal of Surgery. 2011;9(8):648–51.
  13. Rettig ME, Raskin KB. Galeazzi fracture-dislocation: A new treatment-oriented classification. The Journal of Hand Surgery. 2001;26(2):228–35
  14. Kakar S, Carlsen BT, Moran SL, Berger RA. The management of chronic distal radioulnar instability. Hand Clin 2010; 26: 517e28.
  15. Petersen MS, Adams BD. Biomechanical evaluation of distal radioulnar reconstructions. J Hand Surg Am 1993; 18: 328e34.
  16. Adams BD, Berger RA. An anatomic reconstruction of the distal radioulnar ligaments for posttraumatic distal radioulnar joint instability. J Hand Surg Am 2002; 27: 243e51.
  17. Darrach W, Nolan WB, Eaton RG. Partial Excision of Lower Shaft of Ulna for Deformity Following Colles??s Fracture. Clinical Orthopaedics and Related Research. 1992;&NA;(275).
  18. Kapandji AI. The Sauvé-Kapandji Procedure. Journal of Hand Surgery. 1992;17(2):125–6.
  19. White GM, Weiland AJ. Madelungs deformity: Treatment by osteotomy of the radius and Lauenstein procedure. The Journal of Hand Surgery. 1987;12(2):202
  20. Wood VE, Sauser D, Mudge D. The treatment of hereditary multiple exostosis of the upper extremity. The Journal of Hand Surgery. 1985;10(4):505–13.
How to Cite this article: Bhat A, Fijad, NR. Distal Radioulnar Joint injuries: Surgical anatomy, physical examination, Imaging and principles of management. J Kar Orth Assoc. Jan-April 2019; 7(1): 2-8.

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Functional Outcome of Intra-articular Distal Humerus Fractures in Adults Treated with Bicolumnar Plating using Pre-contoured Distal Humerus Locking Plates: A Prospective Study

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Volume 7 | Issue 1 | Jan – April 2019 | Page: 24-28 | Vinay B Patil, Anand Garampalli, S B Kamareddy, Amar.

Authors: Vinay B Patil [1], Anand Garampalli [1], S B Kamareddy [1], Amar [1].

[1] Department of Orthopedics, Mahadevappa Rampure Medical College, Kalaburagi, Karnataka, India.

Address of Correspondence
Dr. Anand Garampalli,

Department of Orthopedics, M R Medical College, Kalaburagi, Karnataka, India.

E-mail: garampalli@gmail.com

Abstract

Introduction: Distal humerus fractures in adults are relatively uncommon injuries amounting to 2–6% of all fractures and 30% of all elbow fractures. The complex shape of the elbow joint, the adjacent neurovascular structures make these fractures difficult to treat. The present study is undertaken to evaluate the functional outcome of intra-articular distal humerus fractures by open reduction and internal fixation using bicolumnar plating technique.

Materials and Methods: A total of 20 intra-articular distal humerus fractures were operated during December 2015–June 2017 were included in the study. All the patients were operated with pre-countered distal humerus locking plates in orthogonal fashion, and outcome was measured by MEPS, rate of union, rate of complications, and final range of motion. Results: In our series of 20 cases, there were 12 males and 8 females. 5 cases were due to self-fall, 14 were due to RTA, and one due to assault. Out of 20 cases, 4 (20%) were of C1 type of fractures, 14 (70%) were of C2, and 2 (10%) were of C3 type of fractures. Excellent results were seen in 12, good in 5, and fair in 3, according to MEPS. There were 2 cases of superficial infection and 2 cases of ulnar neuropathy, treated accordingly.

Conclusion: Operative treatment with stable anatomical internal fixation using anatomically pre-contoured distal humerus plates should be the line of treatment for all grades of intra-articular distal humerus fractures, as it gives best chance to achieve good elbow function.

Keywords: Intra-articular distal humerus fractures, ORIF, bicolumnar plating, MEPS.

References

1. Athwal GS. Distal Humerus Fractures. In: Rockwood And Green’s Fractures In Adults. Vol , 7’ Ed. Philadelphia: Lippincott Williams &
Wilkins;2010.p.946—998.

2. Watson – Jones R : Fractures and joint injuries,Vol.2 6th ed. : Churchill Livingstone, 1993, New Delhi

3. Kuntz Jr, David G, Baratz ME. Fractures of the elbow. OrthopClin North Am Jun1999;30(1):37- 61.

4. Jupiter JB, Neff U, Hoizach P, Ailgower M. Intercondylar fractures of the humerus. An operative approach. J Bone Joint SurgAm l985;672):2623S9

5. Athwal, George S, Rispoli, Damian M, Steinmann, Scott P. The anconeus flap transolecranon approach to the distal Humerus. Technical tricks. J Ortho

6. Campbell’s operative Orthopaedics,12th edition,2013

7. Sanchez-Sotelo J, Torchia ME, and O’DriscollSW : Complex distal humeral fractures : Internal fixation with a principle-based parallel plate technique. J Bone Joint Surg Am 2007;89(5);961-969

8. Reising K, Hauschild O, Strohm PC, SuedkampNP : Stabilisation of articular fractures of the distal humerus : early experience with a novel perpendicular plate system. 2009 Jun;40(6) : 611-7. doi : 10.1016/j.injury.2008.12.018. Epub 2009 Apr

9. Michael D. McKee, Tracy L. Wilson, Lucy Winston, Emil H. Schemitsch and Robin R. Richards. Functional Outcome Following Surgical Treatment of Intra-ArticularDistal Humeral Fractures Through a Posterior Approach. J Bone Joint Surg Am.2000;82-A (12):1701-1707.

10. Macko D, Szabo RM. Complications of tension band wiring of olecranon fractures. JBJS Am. 1985;67 : 1396- 401

11. Bryan RS, Morrey BF. Extensive posterior exposure of the elbow: A triceps-sparing approach. Clin OrthopRelat Res. 1982; 166:188-92

12. Rakesh Kumar Gupta,Vinay Gupta, Dickey Richard Marak. Locking plates in distal humerus fractures: study of 43 Patients, Chinese Journal of Traumatology,2013;16(4):207-211

13. Dr. Gurjinder Singh, Dr. HS Sohal, Dr. Rakesh Sharma, Dr.Jatin Banal and Dr. Jagdish Dhake. Outcome of precontoured locking plate fixation in distal humerus fractures, International Journal of Orthopaedics Sciences 2017; 3(1): 145-148

How to Cite this article: Patil V B, Garampalli A, Kamareddy S B, Amar.Functional Outcome of Intraarticular Distal Humerus Fractures in Adults Treated with Bicolumnar Plating using Pre-contoured Distal Humerus Locking Plates: A Prospective Study. J Kar Orth Assoc. Jan-April 2019; 7(1): 24-28.

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Interlaminar Lumbar Epidural Steroid Injections for Pain Relief in Cases of Low Backache due to Disc Prolapse and Canal Stenosis

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Volume 7 | Issue 1 | Jan – April 2019 | Page: 19-23 | Sreedhara K Doddery, Nishanth Ampar.

Authors: Sreedhara K Doddery [1], Nishanth Ampar [2].

[1] Department of Orthopaedics, Prime Medical Centre, Bur Dubai, Dubai

[2] Department of Orthopaedics, Kasturba Medical College, Manipal-Manipal Academy of Higher Education

Address of Correspondence
Dr.Nishanth Ampar
Department of Orthopaedics
Kasturba Medical College,Manipal-MAHE
Email: ortho.dr.nishanth@gmail.com

Abstract

Introduction: Low back pain with or without radicular pain is a common problem with a significant impact on the economic and health status of patients. Various treatment modalities are in use with variable outcome. Epidural injections are one of the most commonly performed interventions to provide early pain relief for low backache with radicular pain. However, the evidence is highly variable with regard to the outcome following the interlaminar epidural steroid injections.

Aim: This study was undertaken to assess the efficacy of epidural steroid injection for providing pain relief in cases of low backache with radiculopathy, due to intervertebral disc prolapse prolapsed intervertebral disc (PID) and canal stenosis.

Methods: Among 77 patients, 69 patients completed the follow-up and were included in the final analysis (48 in PID group and 21 in canal stenosis group). Verbal numeric rating scale (VNRS) and Modified North American Spine Society (NASS) patient satisfaction scores were among the parameters used to evaluate the patients.

Results: The patients from both the groups demonstrated significant improvement in post-injection VNRS scores and showed very good satisfaction based on the NASS patient satisfaction scores, with favorable outcome in terms of pain relief.

Conclusions: Interlaminar lumbar epidural steroid injection is a useful, effective, and safe treatment modality for low back pain with radiculopathy due to lumbar intervertebral disc prolapse and/or canal stenosis.

Keywords: Epidural steroid injection, intervertebral disc prolapse, lumbar canal stenosis.

References

1. Stafford MA, Peng P, Hill DA. Sciatica: A review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management. Br J Anaesth 2007;99:461-73.

2. Onozawa T, Atsuta Y, Sato M, Ikawa M, Tsunekawa H, Feng X, et al. Nitric oxide induced ectopic firing in a lumbar nerve root with cauda equina compression. Clin Orthop Relat Res 2003;408:167-73.

3. Mixter WJ, Barr JS. Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med 1934;211:2105.

4. Lindahl O, Rexed B. Histologic changes in spinal nerve roots of operated cases of sciatica. Acta Orthop Scand 1951;20:21525.

5. Weber H, Holme I, Amlie E. The natural course of acute sciatica with nerve root symptoms in a double-blind placebocontrolled trial evaluating the effect of piroxicam. Spine (Phila PA 1976) 1993;18:1433-8.

6. Stout A. Epidural steroid injections for low back pain. Phys Med Rehabil Clin N Am 2010;21:825-34.

7. Pandey RA. Efficacy of epidural steroid injection in management of lumbar prolapsed intervertebral disc: A Comparison of caudal, transforaminal and interlaminar routes. J Clin Diagn Res 2016;10:RC05-11.

8. Schizas C, Theumann N, Burn A, Tansey R, Wardlaw D, Smith FW, et al. Qualitative grading of severity of lumbar spinal stenosis based on the morphology of the dural sac on magnetic resonance images. Spine (Phila Pa 1976) 2010;35:1919-24.

9. Rezende R, Jacob Júnior C, da Silva CK, de Barcellos Zanon I, Cardoso IM, Batista Júnior JL, et al. Comparison of the efficacy of transforaminal and interlaminar radicular block techniques for treating lumbar disk hernia. Rev Bras Ortop 2015;50:220-5.

10. Beyaz SG. Comparison of transforaminal and interlaminarepidural steroid injections for the treatment of chronic lumbar pain. Rev Bras Anestesiol 2017;67:21-7.

11. Paisley K, Jeffries J, Monroe M, Choma T. Dispersal pattern of injectate after lumbar interlaminar epidural spinal injection evaluated with computerized tomography. Global Spine J 2012;2:27-32.

12. Rabinovitch DL, Peliowski A, Furlan AD. Influence of lumbar epidural injection volume on pain relief for radicular leg pain and/or low back pain. Spine J 2009;9:509-17.

13. Ackerman WE 3rd, Ahmad M. The efficacy of lumbar epidural steroid injections in patients with lumbar disc herniations. Anesth Analg 2007;104:1217-22, tables of contents.

14. Botwin K, Brown LA, Fishman M, Rao S. Fluoroscopically guided caudal epidural steroid injections in degenerative lumbar spine stenosis. Pain Physician 2007;10:547-58.

15. Fukusaki M, Kobayashi I, Hara T, Sumikawa K. Symptoms of spinal stenosis do not improve after epidural steroid injection. Clin J Pain 1998;14:148-51.

16. Friedly JL, Comstock BA, Turner JA, Heagerty PJ, Deyo RA, Sullivan SD, et al. A randomized trial of epidural glucocorticoid injections for spinal stenosis. N Engl J Med 2014;371:11-21.

17. Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: A review of the evidence for an American pain society clinical practice guideline. Spine (Phila PA 1976) 2009;34:1078-93.

18. McGrath JM, Schaefer MP, Malkamaki DM. Incidence and characteristics of complications from epidural steroid injections. Pain Med 2011;12:726-31.

19. Wybier M, Gaudart S, Petrover D, Houdart E, Laredo JD. Paraplegia complicating selective steroid injections of the lumbar spine. Report of five cases and review of the literature. Eur Radiol 2010;20:181-9.

20. Ridley MG, Kingsley GH, Gibson T, Grahame R. Outpatient lumbar epidural corticosteroid injection in the management of sciatica. Br J Rheumatol 1988;27:295-9.

How to Cite this article: Doddery SK, Ampar N. Interlaminar Lumbar Epidural Steroid Injections for Pain Relief in Cases of Low Backache due to Disc Prolapse and Canal Stenosis. Journal of Karnataka Orthopaedic Association.  Jan-April 2019; 7(1): 19-23.

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Quality of Life during Rehabilitation of Distal forearm Fracture: A Pilot Study

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Volume 7 | Issue 1 | Jan – April 2019 | Page: 16-18 | Devanshu Pathak, Prahlad Kadambi, Pushpa Krishna.

Authors: Devanshu Pathak [1], Prahlad Kadambi [1], Pushpa Krishna [2].

[1] Kempegowda Institute of Medical Sciences, Attibabe Road, Banashankari 2nd Stage , Bengaluru, Karnataka 560070 India

[2] Department of Physiology, KIMS Bangalore, Attibabe Road, Banashankari 2nd Stage, Bangalore 560 070

Address of Correspondence

Dr. Prahlad Kadambi
c/o  Dr. Pushpa Krishna 
Prof., Department of Physiology, 
KIMS Bangalore, Attibabe Road, Banashankari 2nd Stage, Bangalore 560 070

Abstract

Introduction: Rehabilitation refers to restoring health by therapy. Studies have suggested that there is deterioration of the quality of life during rehabilitation period of fractures. The aim of this study was to assess the quality of life during the rehabilitation of distal forearm fracture.

Methodology: Qualeffo questionnaire was used to determine the quality of life after obtaining permission from the International Osteoporosis Foundation. Institutional Ethics committee approval was obtained. Seven patients were randomly chosen (Mean age: 32.71 ± 23 years) from the wards of the Department of Orthopaedics, KIMS Hospital, Bengaluru, during September 2016. Inclusion criteria were patients 4 weeks into rehabilitation with distal forearm fracture. The study was explained to them and written consent obtained. The Qualeffo questionnaire was administered by interview method. A Qualeffo index ≥ 2700/4800 was considered as deteriorated quality of life. Data were tabulated and statistical analysis performed using statistical software Statistical Package for the Social Sciences (SPSS) V18.0.

Results: Mean Qualeffo index was 3114.28 ± 800.76. Five of seven patients (71.4%) had a deteriorated quality of life with Qualeffo index ≥ 2700. Mean score of disability disturbance was 3.714 ± 0.88. Mean score of the quality of life perception is 4.571 ± 0.49. There is a positive association between age and Qualeffo score which is statistically significant (r = 0.819, P = 0.023). A negative association between affected side in distal forearm fracture and index of the quality of life perception was observed but is not statistically significant (r= -0.471, P = 0.29).

Conclusion: Quality of life is affected during the rehabilitation of distal forearm fracture. However, the results of the study have to be confirmed with a study in a larger sample size.

Keywords: Quality of life, fracture

References

1. Felce D, Perry J. Quality of life: Its definition and measurement. Res Dev Disabil 1995;16:51-74.

2. Maheshwari J, Vikram AM. Essential Orthopaedics. 5th ed. New Delhi: Jaypee Publishers; 2015. p. 279.

3. Williams N, Challoumas D, Eastwood DM. Does orthopaedic surgery improve quality of life and function in patients with mucopolysaccharidoses? J Child Orthop 2017;11:289-97.

4. Tulsky DS, Rosenthal M. Measurement of quality of life in rehabilitation medicine: Emerging issues. Arch Phys Med Rehabil 2003;84:S1-2.

5. Goldhahn J, Beaton D, Ladd A, Macdermid J, Hoang-Kim A, Distal Radius Working Group of the International Society for Fracture Repair (ISFR). et al. Recommendation for measuring clinical outcome in distal radius fractures: A core set of domains for standardized reporting in clinical practice and research. Arch Orthop Trauma Surg 2014;134:197-205.

6. Tadic I, Vujasinovic Stupar N, Tasic L, Stevanovic D, Dimic A, Stamenkovic B, et al. Validation of the osteoporosis quality of life questionnaire QUALEFFO-41 for the Serbian population. Health Qual Life Outcomes 2012;10:74.

7. Alexiou KI, Roushias A, Varitimidis SE, Malizos KN. Quality of life and psychological consequences in elderly patients after a hip fracture: A review. Clin Interv Aging 2018;13:143-50.

8. Griffin XL, Parsons N, Achten J, Fernandez M, Costa ML. Recovery of health-related quality of life in a United Kingdom hip fracture population. The Warwick hip trauma evaluation a prospective cohort study. Bone Joint J 2015;97-B:372-82.

9. Ho JD, Al-Haseni A, Smith S, Bhawan J, Sahni D. Bullous complex regional pain syndrome: A description of the clinical and histopathologic features. J Cutan Pathol 2018;45:633-5.

10. Kiecolt-Glaser JK, Page GG, Marucha PT, MacCallum RC, Glaser R. Psychological influences on surgical recovery. Perspectives from psychoneuroimmunology. Am Psychol 1998;53:1209-18.

11. Kalache A, Gatti A. Active ageing: A policy framework. Adv Gerontol 2003;11:7-18.

12. Gutwinski S, Löscher A, Mahler L, Kalbitzer J, Heinz A, Bermpohl F, et al. Understanding left-handedness. Dtsch Arztebl Int 2011;108:849-53.

How to Cite this article: Pathak D, Kadambi P, Krishna P. Quality of Life during Rehabilitation of Distal forearm Fracture: A Pilot Study. J Kar Orth Assoc. Jan-April 2019; 7(1): 16-18.

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Comparison of Functional and Radiological Outcome of Children Aged 5-10 years with Clubfoot Treated Previously Either by Ponseti Method or Surgical Release – A Minimum 4-year Follow-up (Case Series of 28 Children as Cross-sectional Study)

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Volume 7 | Issue 1 | Jan – April 2019 | Page: 9-15 | M Ajith Kumar, Shah Jay Rajesh.

Authors: M Ajith Kumar [1], Shah Jay Rajesh[1].

[1] Department of Orthopaedics, Tejasvini Hospital and SSIOT, Mangalore, Karnataka, India.

Address of Correspondence
Dr. Shah Jay Rajesh,
Tejasvini Hospital and SSIOT,
Kadri Road, Mangalore, Karnataka, India.
Email: Shah.jay.003@gmail.com

Abstract

Aim: This study aims to compare the functional outcome in children aged 5-10 years with clubfoot previously treated by either Ponseti or posteromedial soft tissue release (PMSTR) with minimum follow-up of 4 years following final casting.

Objectives: The objectives of this study were as follows: (1) To compare the functional outcome between the two methods, (2) to determine whether correlation exists between functional outcome and radiographic measurements of both groups, and (3) to compare results with the literature.

Materials and Methods: The study was conducted in Tejasvini Hospital and SSIOT. Medical records of clubfoot patients operated between January 2008 and December 2011 were reviewed. Communication was sent to them and scheduling of appointments for the assessment was made. 28 patients with 45 feet who met the inclusion criteria were assessed. Objective evaluation was made using standard standing AP/lateral foot radiographs and subjective evaluation was made using LaavegPonseti 100-point scoring system includes subjective and objective questionnaire and tabulated. The observation was subjected to statistical analysis.

Results: (1) Of 45 foots, Laaveg-Ponseti score showed excellent in 18 feet, good in 16 feet, moderate in 4 feet, and poor in 7 feet, (2) patient managed with Ponseti has higher excellent/good outcome as compared to PMSTR (90.5% and 62.5%, respectively) but not to the point of statistically significant with P = 0.152, (3) lower talo-1st metatarsal lateral (TMT-LT) (P = 0.004), lower TMT anteroposterior (AP) (P = 0.001), lower calcaneum-5th metatarsal AP (P = 0.005), and high talocalcaneal angle in lateral (P = 0.015) angles are correlated with excellent/good functional outcome with statistically significant P < 0.05, and (4) there were no other significant correlations between the functional and radiographic outcomes.

Conclusion: (1) Our study supports the routine use of radiography during follow-up and using wide range of parameters instead of anyone radiologic parameter, (2) serial manipulation and casting are the preferred initial treatment of choice for idiopathic clubfeet, and soft tissue release is reserved for clubfeet that cannot be completely corrected as it will lead to stiff painful foot and low functional outcome. A strict brace compliance remains the major challenge of the Ponseti method.

Key words: Forefoot adduction on weight-bearing, Calcaneal varus on weight-bearing, Anteroposterior, Lateral, Left, Right, Female, Male, Talus-1st metatarsal angle (LATERAL), 1st–-5th metatarsal angle (LATERAL), Talus-1st metatarsal angle (anteroposterior), Calcaneus-5th metatarsal angle (anteroposterior), Talocalcaneal angle (anteroposterior), Talocalcaneal angle (LATERAL), Congenital talipes equinovarus (clubfoot).

References

1. Phillips D. Incidence, Prevalence and Challenges of Managing CTEV in the Top End. 13th National Rural Health Conference.

2. Laaveg SJ, Ponseti IV. Long-term results of treatment of congenital club foot. J Bone Joint Surg Am 1980;62:23-31.

3. Simons GW. A standardized method for the radiographic evaluation of clubfeet. Clin Orthop Relat Res 1978;135:10718.

4. Cooper DM, Dietz FR. Treatment of idiopathic clubfoot. A thirtyyear follow-up note. J Bone Joint Surg Am 1995;77:1477-89.

5. Ippolito E, Farsetti P, Caterini R, Tudisco C. Long-term comparative results in patients with congenital clubfoot treated with two different protocols. J Bone Joint Surg Am 2003;85A:1286-94.

6. Dobbs MB, Gurnett CA. Update on clubfoot: Etiology and treatment. Clin Orthop Relat Res 2009;467:1146-53.

7. Fridman MW, de Almeida Fialho HS. The role of radiographic measurements in the evaluation of congenital clubfoot surgical results. Skeletal Radiol 2007;36:129-38.

8. Singh BI, Vaishnavi AJ. Modified turco procedure for treatment of idiopathic clubfoot. Clin Orthop Relat Res 2005;438:209-14.

9. Prasad P, Sen RK, Gill SS, Wardak E, Saini R. Clinicoradiological assessment and their correlation in clubfeet treated with postero-medial soft-tissue release. Int Orthop 2009;33:225-9.

10. Munshi S, Varghese RA, Joseph B. Evaluation of outcome of treatment of congenital clubfoot. J Pediatr Orthop 2006;26:664-72.

11. Herbsthofer B, Eckardt A, Rompe JD, Küllmer K. Significance of radiographic angle measurements in evaluation of congenital clubfoot. Arch Orthop Trauma Surg 1998;117:3249.

12. Abulsaad M, Abdelgaber N. Correlation between clinical outcome of surgically treated clubfeet and different radiological parameters. Acta Orthop Belg 2008;74:489-95.

How to Cite this article: Ajith M, Shah J R. Comparison of Functional and Radiological Outcome of Children Aged 5-10 years with Clubfoot Treated Previously Either by Ponseti Method or Surgical Release – A Minimum 4-year Follow-up (Case Series of 28 Children as Cross-sectional Study). . J Kar Orth Assoc. Jan-April 2019; 7(1): 9-15.

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Superolateral Anterior Hip Dislocation with Acetabular Fracture: Report of Three Cases and Review of Literature

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Volume 7 | Issue 1 | Jan – April 2019 | Page: 39-41 | Sandeep Vijayan, Monish Malhotra, Monappa V Naik, Sharath K Rao

Authors: Sandeep Vijayan [1], Monish Malhotra [2], Monappa V Naik [1], Sharath K Rao [1].

[1] Department of Orthopaedics, Kasturba medical college, Manipal University, Manipal, Karnataka, India,
[2] Department of Orthopaedics, Pandit Bhagwat Dayal Sharma PGIMS Rohtak, Haryana, India.

Address of Correspondence
Dr. Monish Malhotra,
Department of Orthopaedics, Pandit Bhagwat Dayal Sharma PGIMS Rohtak, Haryana – 124001, India.
Email: Drmonish.malhotra14@gmail.com

Abstract

Anterior hip dislocation is less common than posterior and is classified as obturator (perineal), pubic, or iliac type. Type of dislocation is influenced by the position of lower limb at the time of injury and forces involved. Superolateral (iliac) type of anterior dislocation is extremely rare and often mistaken for posterior dislocation. Techniques for reducing an anterior dislocation vary with the type. Even though, in general, anterior dislocations have favorable outcome, the presence of associated acetabular injuries and timing of reduction after the injury can influence long-term outcome. Prompt and gentle maneuvers and avoiding repeated attempts at closed reduction further help to improve the prognosis.
Keywords: Hip, Dislocation, Anterior, Superior, Iliac, Acetabulum.

References

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5. Epstein HC. Posterior fracture-dislocations of the hip: Comparison of open and closed methods of treatment in certain types. J Bone Joint Surg Am 1961;43:1079-98.
6. Bassett LW, Gold RH, Epstein HC. Anterior hip dislocation: Atypical superolateral displacement of the femoral head. AJR Am J Roentgenol 1983;141:385-6.
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9. Sultan A, Dar TA, Wani MI, Wani MM, Shafi S. Bilateral simultaneous anterior obturator dislocation of the hip by an unusual mechanism-a case report. Ulus Travma Acil Cerrahi Derg 2012;18:455-7.
10. Chung KJ, Eom SW, Noh KC, Kim HK, Hwang JH, Yoon HS, et al. Bilateral traumatic anterior dislocation of the hip with an unstable lumbar burst fracture. Clin Orthop Surg 2009;1:114-7.
11. Yang EC, Cornwall R. Initial treatment of traumatic hip dislocations in the adult. Clin Orthop Relat Res 2000;377:24-31.
12. Jindal N, Sankhala SS. Superior dislocation hip with anterior column acetabular fracture-open reduction and internal fixation using a twin incision technique. Pan Afr Med J 2012;12:41.
13. Olcay E, Adanır O, Ozden E, Barış A. Bilateral asymmetric traumatic hip dislocation with bilateral acetabular fracture: Case report. Ulus Travma Acil Cerrahi Derg 2012;18:355-7.
14. Dreinhöfer KE, Schwarzkopf SR, Haas NP, Tscherne H. Isolated traumatic dislocation of the hip. Long-term results in 50 patients. J Bone Joint Surg Br 1994;76:6-12.
15. Reggiori A, Brugo G. Traumatic anterior hip dislocation associated with anterior and inferior iliac spines avulsions and a capsular-labral lesion. Strategies Trauma Limb Reconstr 2008;3:39-43.
16. Chadha M, Agarwal A, Singh AP. Traumatic anterior dislocation of the hip joint with posterior acetabular wall fracture. Acta Orthop Belg 2005;71:111-4.
17. Goddard NJ. Classification of traumatic hip dislocation. Clin Orthop Relat Res 2000;377:11-4.

How to Cite this article: Vijayan S, Malhotra M, Naik M V, Rao S K. Superolateral Anterior Hip Dislocation with Acetabular Fracture: Report of Three Cases and Review of Literature. J Kar Orth Assoc. Jan-April 2019; 7(1): 39-41.

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Albers-Schönberg Disease (Marble Bone Disease) – A Clinical Case Repor

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Volume 7 | Issue 1 | Jan – April 2019 | Page: 34-38 | Owais Ahmed, Mallangouda S Patil

Authors: Owais Ahmed [1], Mallangouda S Patil [1].

[1] Department of Orthopaedics Al-ameen Medical College and Hospital Athani Road, Vijayapura, Karnataka, India.

Address of Correspondence
Dr. Mallangouda S Patil,
Department of Orthopaedics Al-ameen Medical College and Hospital Athani Road,
Vijayapura – 586108, Karnataka, India.
E-mail: mallangoudapatil721@yahoo.com

Abstract

Background: Albers-Schönberg disease (marble bone disease) is an adult autosomal dominant Type II osteopetrosis, caused by severe impairment of osteoclast-mediated bone resorption due to a mutation in CLCN-7 gene on chromosome 16q13.3; it is diagnosed incidentally based on the presence of a pathological fracture, which usually involves proximal femur and hip. A case of 21 years’ female patient who was brought to casualty with a subtrochanteric fracture of the left femur after a trivial trauma. History of fracture shaft of the right femur 7 years back diagnosed as pathological fracture due to osteopetrosis and treated surgically with plate and screws. In this case, open reduction internal fixation using dynamic hip screw (without autologous bone graft) was preferred over nonoperative modality for accurate reduction, stable fixation, early mobilization, fewer complications, and better functional outcome. Surgical treatment of fracture in these cases is a challenge to an orthopedic surgeon due to intraoperative difficulties and post-operative complications. Even though with intraoperative difficulties, operative modalities should be considered for a better outcome which requires proper pre-operative planning, with meticulous intraoperative skills and planned post-operative care.
Keywords: Osteopetrosis, Pathological fracture, Rugger-Jersey Spine, Dynamic hip screw, Femur.

References

1. Albers-Schonberg H. Roentgenbilder einer seltenen knochennerkrankung. Munch Med Wochenschr 1904;51:365.
2. Karshner R. Osteopetrosis. Am J Roentgenol 1926;16:405-19.
3. Sobacchi C, Schulz A, Coxon FP, Villa A, Helfrich MH. Osteopetrosis: Genetics, treatment and new insights into osteoclast function. Nat Rev Endocrinol 2013;9:522-36.
4. Stark Z, Savarirayan R. Osteopetrosis. Orphanet J Rare Dis 2009;4:5.
5. Sly WS, Hewett-Emmett D, Whyte MP, Yu YS, Tashian RE. Carbonic anhydrase II deficiency identified as the primary defect in the autosomal recessive syndrome of osteopetrosis with renal tubular acidosis and cerebral calcification. Proc Natl Acad Sci U S A 1983;80:2752-6.
6. Bollerslev J, Mosekilde L. Autosomal dominant osteopetrosis. Clin Orthop Relat Res 1993;294:45-51.
7. Bollerslev J, Henriksen K, Nielsen MF, Brixen K, Van Hul W. Autosomal dominant osteopetrosis revisited: Lessons from recent studies. Eur J Endocrinol 2013;169:R39-57.
8. Bénichou OD, Laredo JD, de Vernejoul MC. Type II autosomal dominant osteopetrosis (albers-schönberg disease): Clinical and radiological manifestations in 42 patients. Bone 2000;26:87-93.
9. de Vernejoul MC, Kornak U. Heritable sclerosing bone disorders: Presentation and new molecular mechanisms. Ann N Y Acad Sci 2010;1192:269-77.
10. de Vernejoul MC, Schulz A, Kornak U. CLCN7-related osteopetrosis. GeneReviews 2007;???:???.
11. de Palma L, Tulli A, Maccauro G, Sabetta SP, del Torto M. Fracture callus in osteopetrosis. Clin Orthop Relat Res 1994;308:85-9.
12. Armstrong DG, Newfield JT, Gillespie R. Orthopedic management of osteopetrosis: Results of a survey and review of the literature. J Pediatr Orthop 1999;19:122-32.
13. Chhabra A, Westerlund LE, Kline AJ, McLaughlin R. Management of proximal femoral shaft fractures in osteopetrosis: A case series using internal fixation. Orthopedics 2005;28:587-92.
14. Amit S, Shehkar A, Vivek M, Shekhar S, Biren N. Fixation of subtrochanteric fractures in two patients with osteopetrosis using a distal femoral locking compression plate of the contralateral side. Eur J Trauma Emerg Surg 2010;36:263-9.
15. Bollerslev J, Andersen PE Jr. Fracture patterns in two types of autosomal-dominant osteopetrosis. Acta Orthop Scand 1989;60:110-2.
16. Osuna PM, Santoz-Guzman J, Viellela L, Garcia A. Osteopetrosis-calcification beyond the skeletal system. A case report clinical case. Bol Méd Hosp Infant Méx 2012;69:109-13.
17. Rysavy M, Arun KP, Wozniak A. Fracture treatment in intermediate autosomal recessive osteopetrosis. Orthopedics 2007;30:577-80.
18. Özcan AÜ, Ocak FŞ, Ratip S. A rare case of osteopetrosis tarda: Radiographic signs. Acıbadem Üniv Sağlık Bilimleri Derg 2012;3:79-81.
19. Kumbaraci M, Karapinar L, Incesu M, Kaya A. Treatment of bilateral simultaneous subtrochanteric femur fractures with proximal femoral nail antirotation (PFNA) in a patient with osteopetrosis: Case report and review of the literature. J Orthop Sci 2013;18:486-9.
20. Khan MN, Datta PK, Hasan MI, Hossain MA, Patwary KH, Ferdous J, et al. Osteopetrosis. Mymensingh Med J 2011;20:715-8.
21. Bénichou O, Cleiren E, Gram J, Bollerslev J, de Vernejoul MC, Van Hul W, et al. Mapping of autosomal dominant osteopetrosis Type II (albers-schönberg disease) to chromosome 16p13.3. Am J Hum Genet 2001;69:647-54.
22. Van Hul W, Bollerslev J, Gram J, Van Hul E, Wuyts W, Benichou O, et al. Localization of a gene for autosomal dominant osteopetrosis (albers-schönberg disease) to chromosome 1p21. Am J Hum Genet 1997;61:363-9.
23. Ihde LL, Forrester DM, Gottsegen CJ, Masih S, Patel DB, Vachon LA, et al. Sclerosing bone dysplasias: Review and differentiation from other causes of osteosclerosis. Radiographics 2011;31:1865-82.
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How to Cite this article: Ahmed O, Patil M S. Albers-Schönberg Disease (Marble Bone Disease) – A Clinical Case Repor. J Kar Orth Assoc. Jan-April 2019; 7(1): 34-38.

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Epidermoid Cyst in Tendon Achilles Following Percutaneous Tenotomy in Congenital Talipes Equinovarus: A Case Report

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Volume 7 | Issue 1 | Jan – April 2019 | Page: 32-33| Mohamed Faheem Kotekar, Muthur Ajith Kumar, Shah Jay Rajesh

Authors: Mohamed Faheem Kotekar [1], Muthur Ajith Kumar [1], Shah Jay Rajesh  [1].

[1] Department of Orthopaedics, Tejasvini Hospital, Mangalore, Karnataka, India.

Address of Correspondence
Dr. Shah Jay Rajesh,
Tejasvini Hospital, Mangalore, Karnataka, India.
Email: shah.jay.003@gmail.com

Abstract

An unusual case of implantation dermoid cyst of the tendoachilles which was symptomatic . This report discusses the possibility of such implantation dermoid cysts after percutaneous procedures such as the percutaneous tendon Achilles tenotomy for congenital talipes equinovarus.
Keywords : CTEV, Epidermoid cyst

References

1. Józsa L, Réffy A, Kannus P, Demel S, Elek E. Pathological alterations in human tendons. Arch Orthop Trauma Surg 1990;110:15-21.
2. Lucas GL. Epidermoid inclusion cysts of the hand. J South Orthop Assoc 1999;8:188-92.
3. Ponseti IV. Congenital Clubfoot: Fundamental of Treatment. Oxford: Oxford University Press; 1996.
4. Carroll NC. Clubfoot in the twentieth century: Where we were and where we may be going in the twenty-first century. J Pediatr Orthop B 2012;21:1-6.
5. Dobbs MB, Gordon JE, Walton T, Schoenecker PL. Bleeding complications following percutaneous tendoachilles tenotomy in the treatment of clubfoot deformity. J Pediatr Orthop 2004;24:353-7.
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7. Burghardt RD, Herzenberg JE, Ranade A. Pseudoaneurysm after ponseti percutaneous achilles tenotomy: A case report. J Pediatr Orthop 2008;28:366-9.
8. Lewis TR, Taylor A, Haynes J. Ruptured pseudoaneurysm after percutaneous achilles tenotomy during ponseti treatment for congenital clubfoot deformity: A case report. JBJS Case Connect 2013;3:e11.

How to Cite this article: Kotekar M F, Kumar M A, Shah J R. Epidermoid Cyst in Tendon Achilles Following Percutaneous Tenotomy in Congenital Talipes Equinovarus: A Case Report. J Kar Orth Assoc. Jan-April 2019; 7(1): 32-33.

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