The Effect of Surgical Reduction of Isthmic Spondylolisthesis at the Lumbosacral Junction on Spinopelvic Morphology

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Volume 7 | Issue 2 | May – August 2019 | Page: 2-7  | Mrinal B Shetty , Vinayak Venugopal

Authors: Mrinal B Shetty [1], Vinayak Venugopal [2].

[1] Department of Orthopaedics, Division of Spine Surgery, Father Muller Medical College, Kankanady, Mangalore, Karnataka,
[2] Department of Orthopaedics, Father Muller Medical College, Kankanady, Mangalore, Karnataka, India.

Address of Correspondence
Dr. Vinayak Venugopal,
Department of Orthopaedics, Father Muller Medical College,
Kankanady, Mangalore, Karnataka, India.
E-mail:vinu.scorpio@gmail.com

Abstract

Purpose: Spondylolisthesis, with abnormal sacropelvic morphology, tends to disturb the normal spinopelvic sagittal balance and results in abnormal sacropelvic orientation. Publications have emphasized the techniques of reduction and associated complications, but there is little knowledge of the effect of the reduction of sagittal plane translation in spondylolisthesis on the sagittal balance of spine and pelvis in post-operative patients. Therefore, there is a need for more studies concerning the spinopelvic parameters in patients undergoing surgical reduction for isthmicspondylolisthesis.
Our aim through this study is to describe the clinical and radiological impact of the reduction of sagittal plane translation and rotation in isthmic spondylolisthesis at lumbosacral junction following reduction and interbody fusiontransforaminal lumbar interbody fusion (TLIF) on pelvic and spinal parameters.
Materials and Methods: Adult patients undergoing surgical reduction and TLIF for isthmic spondylolisthesis at lumbosacral junction satisfying inclusion and exclusion criteria who have been admitted or treated under Unit of Spine Surgery, Department of Orthopaedics at Father Muller Medical College between August 1, 2016,and June 1, 2018.From the 18 patients included in the study, collected data were analyzed by frequency, percentage, mean, and standard deviation. Tests such as Friedman test were used to compare the parameters over different time point and posthoc analysis was carried out using Wilcoxon signed-rank test.
Results: Of the 18 patients included in the study followed up for a period of 1 year,77.8% were female and 22.2% were male. Average lumbar lordosis (LL) improved from 46.17° ± 7.57° to 57.87°± 1.95° at the end of 1 year(P = 0.000).Mean pelvic tilt (PT) preoperatively was 25°± 8.95°, which reduced to 18.10°± 2.29° at the end of 1 year. Average pre-operative sacral slope(SS)was 32.33° which increased to 39.23° at the end of 1 year. Pelvic incidence remained a constant irrespective of the intervention. Preoperatively, the average sagittal vertical axis (SVA) was 4.03cm which indicates sagittal imbalance; at the end of 1 year, SVA was 2.40cm which indicates a well-balanced spine. The mean pre-operative Oswestry Disability Index (ODI) was 55.67± 9.46 which suggested moderate-to-severe disability as per the ODI scoring system, which improved to 12.00± 3.36 which indicates minimal disability. Preoperatively, average visual analog scale (VAS) score was 8 which reduced to 0.17 at the end of 1 year, which is a significant decline in the pain with minimal or no pain by the end of 12months.
Conclusion: The procedure resulted in adequate reduction of listhesis, restoration of sagittal balance of spine, improvement of other spinopelvic parameters (PT, SS and LL), adequate fusion of the lumbosacral junction, and less morbidity (indicated by VAS and ODI score). Hence, the measurement of spinopelvic parameters is of utmost importance in pre-operative planning, with the aim of surgery then being to restore these deranged parameters to normal ranges. Reduction of translational as well as rotational component of spondylolisthesis with interbody fusion (TLIF) is an effective technique which restores the sagittal balance of spine, improves LL, improves fusion rate, and reduces the rate of adjacent segment disease as well as morbidity.
Keywords: Isthmic spondylolisthesis, reduction of listhesis, spinopelvic parameters.

References

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How to Cite this article: Shetty M B, Venugopal V. The Effect of Surgical Reduction of Isthmic Spondylolisthesis at the Lumbosacral Junction on Spinopelvic Morphology. Journal of Karnataka Orthopaedic Association May-Aug 2019; 7(2): 2-7.

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Timing of Antibiotic and Wound Debridement: Does it Matters in Open Fractures of Long Bones.

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Volume 7 | Issue 2 | May – August 2019 | Page: 11- 16 | Monappa Naik A, Raviteja Jampani, Mahesh Suresh Kulkarni, Sandeep Vijayan, Sourabh Shetty, Sharath K Rao, Nirish Reddy

Authors: Monappa Naik A [1], Raviteja Singasani [1], Mahesh Suresh Kulkarni* [1], Sandeep Vijayan [1], Sourabh Shetty [1], Sharath K Rao [1], Nirish Reddy [1].

[1] Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka 576104, India.

Address of Correspondence
Dr. Mahesh Suresh Kulkarni*,
Department of Orthopaedics, Kasturba Medical College,
Manipal Academy of Higher Education (MAHE), Manipal, Udupi, Karnataka 576104, India.
E-mail: maheshskulkarnibmc@gmail.com

Abstract

Background: Open fractures are known to have a multitude of complications. In general, open fractures have been considered as a surgical emergency and treated accordingly with emergency debridement and fixation. Previous animal studies emphasized the need for early debridement and antibiotic administration. However, similar results are not observed and translated in the clinical setting. Hence, we designed an observational study in which our aim was to evaluate the factors which determine union and infections following open long-bone fractures.
Materials and Methods: This is a retro prospective study conducted in a tertiary care hospital from 2015 to 2017. All the open fractures of long bones presented to the casualty not later than 48 h of the injury who were skeletally mature included in the study after obtaining informed consent. All the patients who were presented with the open long-bone injuries were treated as per the institution protocol. Patients were followed up regularly and evaluated.
Results: 59 patients with 69 open fractures were considered for the analysis. Type IIIB and C open fractures were significantly more common in lower-limb injuries. There was no significant difference found between the mean age, gender, involved limb, affected side, presence of the comorbidities, mean time between the injury and the presentation, mean time between injury, and the start of the antibiotics between infected/non-infected and united/non-united open fractures. High-grade injuries took significantly higher number of procedures and time to achieve wound closure. Furthermore, cases with infection and non-union have taken significantly more number of procedures to achieve wound closure. An associated bone loss had a significant increase in the infection, bone grafting, and non-union.
Conclusion: In our study, we noted that open fracture severity and bone loss are the main factors which determine the chances of culture-proven infection. Early antibiotics and wound debridement will not necessarily translate into a decrease in infection rates and non-union.
Keywords: Open fractures, non-union, osteomyelitis, infection, long-bone fractures, bone grafting, soft-tissue injuries.

References

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How to Cite this article: Naik M A, Singasani R, Kulkarni M S*, Vijayan S, Shetty S, Rao S K, Reddy N. Timing of Antibiotic and Wound Debridement: Does it Matters in Open Fractures of Long. Journal of Karnataka Orthopaedic Association May – Aug 2019 ; 7(2): 11-16.

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Recurrent Giant Cell Tumor of Sacrum Treated with Denosumab: A Case Report

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Volume 7 | Issue 2 | May – August 2019 | Page: 38-42 | Pramod Chinder, Suresh Rao, Naveen Joseph Mathai, Manjeshwar Shrinath Baliga

Authors: Pramod Chinder [1], Suresh Rao [2], Naveen Joseph Mathai [3], Manjeshwar Shrinath Baliga [2].

[1] Department of Ortho-Oncology, Mangalore Institute of Oncology, Mangalore, Karnataka India,
[2] Department of Radiation Oncology, Mangalore Institute of Oncology, Mangalore, Karnataka India,
[3] Department of Trauma andOrthopaedics, University Hospital of Wales, Cardiff, UK.

Address of Correspondence
Dr. Suresh Rao,
Department of Radiation oncology,
Mangalore institute of Oncology, Mangalore
E-mail: raos_64@yahoo.com

Abstract

Giant cell tumor of the bone (GCTB) is a benign but locally aggressive tumor which has a predilection for the epiphyseo-metaphyseal region of long bones. However, the occurrence of GCT in surgically inaccessible locations such as the vertebrae and pelvis poses a daunting challenge. Receptor activator of nuclear factor kappa-B (RANK)-ligand binder, denosumab is a fully human monoclonal antibody which inhibits cells which expresses RANK ligand which is expressed in GCT. We report an unusual case report of recurrent GCT arising from the sacrum in a young man treated with denosumab. He underwent administration of denosumab pre-operatively and post-operatively whereby there was remission of the tumor. As a measure of “success,” we indicate the social functioning-36 and WHO questionnaire which indicate a good quality of life.
Keywords: Giant cell tumor of the bone, denosumab, sacrum.

References

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How to Cite this article: Chinder P, Rao S, Mathai N J, Shrinath Baliga M S. Recurrent Giant Cell Tumor of Sacrum Treated with Denosumab: A Case Report. Journal of Karnataka Orthopaedic Association. May-Aug 2019; 7(2): 38-42.

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Tuberculosis of the Iliac Crest – A Rare Case

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Volume 7 | Issue 2 | May – August 2019 | Page: 31-33 | Preetham. N

Authors: Preetham. N [1].

[1] Department of Orthopaedics, Bangalore Medical College and Research Institute Bangalore.

Address of Correspondence
Dr. Preetham. N,
Department of Orthopaedics, Bangalore Medical College and
Research Institute Bangalore.
E-mail: preetham_1875@yahoo.co.in

Abstract

Tuberculous osteomyelitis is common, but isolated involvement of the ilium bone is a rare entity. We describe a case that had an insidious onset of symptoms and the red flag sign being worsening of symptoms, despite various antibiotic regimens. Histopathological demonstration of necrotizing granulomatous inflammation led to the diagnosis. Surgical excision and antitubercular therapy resulted in clinical recovery. Rarity of iliac crest tuberculosis and its atypical presentation often leads to delay in diagnosis. This case report highlights some of the key features that help in early diagnosis and treatment.
Keywords: Tuberculosis, Iliac crest, Curettage, Biopsy

References

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17. Vijay PG, Joseph MV. Retrospective analysis of varied clinical presentations and delayed diagnosis in tuberculosis affection of extremities. J Orthop Case Rep 2012;2:12-6.
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How to Cite this article: preetham N. Tuberculosis of the Iliac Crest – A Rare Case. Journal of Karnataka Orthopaedic Association. May-Aug 2019; 7(2): 31-33.

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Anterior Dislocation of Hip with Ipsilateral Neck of Femur Fracture – A Case Report

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Volume 7 | Issue 2 | May – Aug 2019 | Page: 43-45 | A A Hosangadi, Vinod Makannavar, B Karthik, Suryakanth Kalluraya

Authors: A A Hosangadi [1], Vinod Makannavar [1], B Karthik1, Suryakanth Kalluraya [1].

[1] Department of Orthopaedics, Karnataka Institute of medical science, Hubli, Karnataka, India.

Address of Correspondence
Dr. Vinod Makannavar
Senior Resident, Department of Orthopaedics,
Karnataka Institute of medical science, Hubli, Karnataka, India.
Email: drvinod001@gmail.com

Abstract

Combined fracture neck femur with anterior dislocation of the head of femur is a very rare and with little resources available in the literature. We hereby report a case condition treated by unipolar arthroplasty with Austin Moore prosthesis with 6-month follow-up showing good radiological and functional outcome. Functional evaluation at the end of follow-up was assessed according to Merle d’Aubigné score modified by Matta JM, which takes into account of the presence of pain, ability to walk, and joint range of motion. The measured functional score was 15 points out of a maximum of 18, signifying a good post-operative result.
Keywords: Anterior hip dislocation, Avascular necrosis.

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6. McClelland SJ, Bauman PA, Medley CF, Jr, Shelton ML. Obturator hip dislocation with ipsilateral fractures of the femoral head and femoral neck. A case report. Clin Orthop Relat Res. 1987:164–8
7. Esenkaya I, Gorgec M. Dislocation of the hip and ipsilateral femoral neck fracture. Acta Orthop Traumatol Turc 2002;36:366-8.
8. Dümmer RE, Sanzana ES. Hip dislocations associated with ipsilateral femoral neck fracture. Int Orthop 1999;23:353-4.
9. Thuan VL, Swiontkowski MF. Management of femoral neck fractures in young adults. Indian J Orthop 2008;42:3-12.

How to Cite this article: Hosangadi A A, Makannavar V, Karthik B, Kalluraya S. Anterior Dislocation of Hip with Ipsilateral Neck of Femur Fracture- A Case Report. May-Aug 2019; 7(2): 43-45.

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Femoral Arterial Thrombosis Post Total Knee Arthroplasty – A Rare but Dreaded Complication

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Volume 7 | Issue 2 | May – August 2019 | Page: 27-30  | Mohan Thadi, Prajwal P. Mane, Vijith Vijay

Authors: Mohan Thadi [1] , Prajwal P. Mane [1] , Vijith Vijay [1].

[1] Department Of Orthopaedics, Amrita Institute Of Medical Sciences, Kochi, Kerla,India.

Address of Correspondence
Dr. Prajwal P. Mane,
Arthroplasty Fellow, Department Of Orthopaedics,
Amrita Institute Of Medical Sciences, Kochi, Kerla, India.
E-mail: pjlmane@gmail.com

Abstract

Acute arterial occlusion, a rare complication after total knee arthroplasty (TKA), reportedly has an incidence of 0.03–0.17% which if undetected can result in limb loss. Cases of acute arterial occlusion following TKA reported in the literature have been mainly attributed to the iatrogenic popliteal artery injury. It is important to understand the mechanism of occlusion as it can lead to limb-threatening ischemia. The use of tourniquet and manipulation of the knee joint in an elderly with arteriosclerosis may induce disruption of an atheromatous plaque that could lead to arterial occlusion. Here, we report a rare case of arterial occlusion ofthe femoral artery post-TKA.
Keywords: atherosclerosis, total knee arthroplasty, acute limb ischaemia post knee replacement, femoral vessel thrombus

References

1. Peyron JG. Osteoarthritis. The epidemiologic viewpoint. Clin Orthop Relat Res 1986;213:13-9.
2. Inomata K, Sekiya I, Otabe K, Nakamura T, Horie M, Koga H, et al. Acute arterial occlusion after total knee arthroplasty: A case report. Clin Case Rep 2017;5:1376-80.
3. Khan S, Salam H, Kessels J. Popliteal artery occlusion after total knee replacement: A vascular team approach for limb salvage. Vasc Dis Manage 2014;11:E200-5.
4. Cho MR, Kim KT, Choi WK. Arterial occlusion after total knee arthroplasty despite minimal invasive technique in aneurysm at popliteal artery: Case report. Medicine (Baltimore) 2018;97:e12719.
5. He R, Yang L. Acute arterial occlusion in the midpiece of femoral artery following total knee arthroplasty: Report of one case. Chin J Traumatol 2016;19:116-8.
6. Mathew A, Abraham BJ, Fischer L, Punnoose E. Popliteal artery thrombosis following total knee arthroplasty managed successfully with percutaneous intervention. BMJ Case Rep 2014;2014:2014206936.
7. Bayne CO, Bayne O, Peterson M, Cain E. Acute arterial thrombosis after bilateral total knee arthroplasty. J Arthroplasty 2008;23:1239.e1-6.
8. Tsujimoto R, Matsumoto T, Takayama K, Kawakami Y, Kamimura M, Matsushita T, et al. Acute popliteal artery occlusion after revision total knee arthroplasty. Case Rep Orthop 2015;2015:672164.
9. Chikkanna JK, Sampath D, Reddy V, Motkuru V. Popliteal artery thrombosis after total knee replacement: An unusual complication. J Clin Diagn Res 2015;9:RJ01-2.
10. Matziolis G, Perka C, Labs K. Acute arterial occlusion after total knee arthroplasty. Arch Orthop Trauma Surg 2004;124:134-6.
11. Junior RF, Amatuzzi MM, Leao PP, Leme LE. Arterial thrombosis in total knee arthroplasty: A literature review. Acta Ortop Bras 2005;13:209-12.
12. Raju IT. Acute limb ischemia secondary to popliteal artery thrombosis following total knee arthroplasty limb salvage by endovascular therapy. Indian J Vasc Endovasc Surg 2018;5:115-8.

How to Cite this article: Thadi M, Mane P P, Vijay V. Femoral Arterial Thrombosis Post Total Knee Arthroplasty – A Rare but Dreaded Complication. Journal of Karnataka Orthopaedic Association May- Aug 2019; 7(2): 27-30.

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A Comparative Study of the Outcome of Wound Drain versus No Drain in Patients Undergoing Primary Total Knee Arthroplasty

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Volume 7 | Issue 2 | May – August 2019 | Page: 8-10  | Srinivasalu Santhanagopal, Manu Jacob Abraham, Joby Kurian, Anoop Pilar

Authors: Srinivasalu Santhanagopal [1], Manu Jacob Abraham [1] , Joby Kurian [1] , Anoop Pilar [1].

[1] Department of Orthopaedics, St Johns Medical College Hospital, Bangalore, India.

Address of Correspondence
Dr. Anoop Pilar,
Department of Orthopaedics,
St Johns Medical College Hospital, Bangalore, India.
Email Id- dranoopp07@gmail.com

Abstract

Total knee arthroplasty (TKA) is a common surgery that reduces pain and significantly improves function and quality of life in patients with knee disorders. Drains in TKR have been used historically for the theoretical benefit of preventing wound hematoma, improving wound healing, and preventing infection. However, literature available to support these beliefs is sparse. The purpose of our study was to assess if a patient undergoing a TKA would benefit from a wound drainage system.
Materials and Methods: Forty-two patients who underwent primary total knee replacement were included in the study; 23 knees in the drained group and 23 knees in the non-drained group. Both the groups had their coagulation workup done and were given deep venous thrombosis prophylaxis as per protocol. A single wound drain system was placed in those patients enrolled in the group with the drains. The outcome was compared between the two groups in terms of blood loss, transfusion requirements, and progression of rehabilitation.
Results: The median drop in Hb was higher in the drained group (2.4 g/dL) compared to the non-drained group (1 g/dL), which statistical analysis was found to be significant (P < 0.001). In the drained group, 65.2% of cases required transfusion, whereas only 21.7% of cases in the non-drained group required transfusions. This was found to be statistically significant (P = 0.01). There was no significant difference in the visual analog score pain scores between the two groups in the post-operative period (P = 0.109). The number of days required to achieve active straight leg raise and knee flexion of 90 degrees was also more in the drained group, which was statistically significant (P < 0.05). The number of days taken for suture removal was found to be higher in the drained group (mean = 12.71) versus the non-drained group (mean = 12.04), and this was found to have statistical significance (P < 0.001).
Conclusions: In our study, the use of a closed drainage system in total knee replacement was associated with higher blood loss postoperatively which essentially translated to an increased requirement of blood transfusions. The progression of wound healing and achievement of post-operative rehabilitation goals were found to be better in the group without the wound drainage system. Although post-operative pain remained to be the same when compared between both the groups.( Kindly review the sentence as it seems to be incomplete.)
Keywords: Drainage, arthroplasty, total knee arthroplasty, blood transfusion, blood loss, wound healing.

References

1. Arden N, Nevitt MC. Osteoarthritis: Epidemiology. Best Pract Res Clin Rheumatol 2006;20:3-25.
2. Ranawat CS. History of total knee replacement. J South Orthop Assoc 2002;11:218-26.
3. Buckwalter JA, Lohmander S. Operative treatment of osteoarthrosis. Current practice and future development. J
Bone Joint Surg Am 1994;76:1405-18.
4. Yoo JH, Chang CB, Kang YG, Kim SJ, Seong SC, Kim TK, et al. Patient expectations of total knee replacement and their association with sociodemographic factors and functional status. J Bone Joint Surg Br 2011;93:337-44.
5. Canty SJ, Shepard GJ, Ryan WG, Banks AJ. Do we practice evidence based medicine with regard to drain usage in knee arthroplasty? Results of a questionnaire of BASK members. Knee 2003;10:385-7.
6. Kohn MD, Sassoon AA, Fernando ND. Classifications in brief: Kellgren-lawrence classification of osteoarthritis. Clin Orthop Relat Res 2016;474:1886-93.
7. Drinkwater CJ, Neil MJ. Optimal timing of wound drain removal following total joint arthroplasty. J Arthroplasty 1995;10:185-9.
8. Reilly TJ, Gradisar IA Jr., Pakan W, Reilly M. The use of postoperative suction drainage in total knee arthroplasty. Clin Orthop Relat Res 1986;208:238-42.
9. Cushner FD, Friedman RJ. Blood loss in total knee arthroplasty. Clin Orthop Relat Res 1991;269:98-101.
10. Esler CN, Blakeway C, Fiddian NJ. The use of a closedsuction drain in total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg Br 2003;85:215-7.
11. Lee QJ, Mak WP, Hau WS, Yeung ST, Wong YC, Wai YL, et al. Short duration and low suction pressure drain versus no drain following total knee replacement. J Orthop Surg (Hong Kong) 2015;23:278-81.

How to Cite this article: Santhanagopal S, Abraham J M, Kurian J, Pilar A. A Comparative Study of the Outcome of Wound Drain versus No Drain in Patients Undergoing Primary Total Knee Arthroplasty.
May-Aug 2019; 7(2): 8-10.

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Extravasation of Irrigation Fluid to External Genitalia during Knee Arthroscopy: A Case Report

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Volume 7 | Issue 2 | May – Aug 2019 | Page: 46-48 | Joseph Eugene Nidhiry, Anoop Pilar, Rajkumar S Amaravathi, Keith Behram Tamboowalla

Authors: Joseph Eugene Nidhiry [1], Anoop Pilar [1], Rajkumar S Amaravathi [1], Keith Behram Tamboowalla [2].

[1] Department of Orthopaedics, St Johns Medical College and Hospital, Bangalore, India
[2] Department of Orthopaedics, Bombay Hospital and Medical Research Centre, New Marine Lines, Mumbai- 400020.

Address of Correspondence
Dr. Anoop Pilar,
Department of Orthopaedics, St Johns Medical College and Hospital, Bangalore, India
E-mail: dranoopp07@gmail.com

Abstract

Extra-articular extravasation of irrigation fluid during arthroscopy is relatively common and is almost always limited to the subcutaneous tissue surrounding entry incisions. There are no complications and the reabsorption rate is fast. The fluid may leak into the thigh, popliteal fossa, or the leg. Fault in pressure sensor in the irrigation pump may cause excessive extravasation of irrigation fluid above the knee joint into the thigh and perineum. We would like to report a rare case of extravasation of irrigation fluid into the external genitalia during arthroscopic anterior cruciate ligament reconstruction.
Keywords: Knee, Anterior cruciate ligament, complication.

References

1. Fowler J, Owens BD. Abdominal compartment syndrome after hip arthroscopy. Arthroscopy 2010;26:128-30.
2. Ekman EF, Poehling GG. An experimental assessment of the risk of compartment syndrome during knee arthroscopy. Arthroscopy 1996;12:193-9.
3. Belanger M, Fadale P. Compartment syndrome of the leg after arthroscopic examination of a tibial plateau fracture. Case report and review of the literature. Arthroscopy 1997;13:646-51.
4. Marti CB, Jakob RP. Accumulation of irrigation fluid in the calf as a complication during high tibial osteotomy combined with simultaneous arthroscopic anterior cruciate ligament reconstruction. Arthroscopy 1999;15:864-6.
5. Arthroscopic irrigation/distention systems. Health Devices 1999;28:242-81.
6. Noyes FR, Spievack ES. Extraarticular fluid dissection in tissues during arthroscopy. A report of clinical cases and a study of intraarticular and thigh pressures in cadavers. Am J Sports Med 1982;10:346-51.
7. Ogilvie-Harris DJ, Weisleder L. Fluid pump systems for arthroscopy: A comparison of pressure control versus pressure and flow control. Arthroscopy 1995;11:591-5.
8. Cavaignac E, Pailhé R, Reina N, Chiron P, Laffosse JM. Massive proximal extravasation as a complication during arthroscopic anterior cruciate ligament reconstruction. Knee Surg Relat Res 2013;25:84-7.
9. Bomberg BC, Hurley PE, Clark CA, McLaughlin CS. Complications associated with the use of an infusion pump during knee arthroscopy. Arthroscopy 1992;8:224-8.
10. Romero J, Smit CM, Zanetti M. Massive intraperitoneal and extraperitoneal accumulation of irrigation fluid as a complication during knee arthroscopy. Arthroscopy 1998;14:401-4.

How to Cite this article: Nidhiry J E, Pilar A, Amaravathi R S, Tamboowalla K B. Extravasation of Irrigation Fluid to External Genitalia during Knee Arthroscopy: A Case Report. Journal of Karnataka Orthopaedic Association. May-Aug 2019; 7(2): 46-48.

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Plantar fasciitis management: A comparative study between plantar fascia stretching exercises versus local corticosteroid injection

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Volume 7 | Issue 2 | May – August 2019 | Page: 17-21  | Prabhu Ethiraj, Sagar Venkataraman, Arun H.S, Abhijeet Salunkhe

Authors: Prabhu Ethiraj [1], Sagar Venkataraman [1] , Arun H.S [1], Abhijeet Salunkhe [1].

[1] Department of Orthopaedics, Sri Devaraj Urs Medical College SDUAHER, Tamaka, Kolar, 563101 Karnataka INDIA

Address of Correspondence
Dr. Sagar Venkataraman,
Department of Orthopaedics, Sri Devaraj Urs Medical College
SDUAHER, Tamaka, Kolar, 563101 Karnataka INDIA
E-mail: drsagarnaik86@gmail.com

Abstract

Background: Plantar fasciitis is one of the common causes of heel pain. Various modalities of treatment have been described in literature are plantar fascia stretching exercises, local corticosteroid injection, extracorporeal shock wave therapy, Platelet rich plasma injection at site of insertion and operative management. Our study was conducted to compare treatment between stretching exercises and local corticosteroid injection in rural population of patients with plantar fasciitis.
Materials and Methods: Our study included 60 patients diagnosed with plantar fasciitis. We divided randomly into two groups. Group 1 included 30 patients treated with stretching exercises, non-steroidal anti-inflammatory medications, microcellular (MCR) footwear and other group 2 includes 30 patients with analgesics, microcellular (MCR) footwear and local corticosteroid injection. Patients were assessed after 2 weeks, 4 weeks, 8 weeks and 12 weeks from start of treatment with regard to pain and function. Pain was assessed using visual analogue scale.
Results: We analyzed our data using Visual Analogue Scale (VAS) where score 0 is no pain and score 10 severe pain. The VAS scores were calculated at 2nd 4th 8th and 12th week. In our study obtained results showed pain severity in group 2 was significantly reduced after 2nd week and 4th week from start of the treatment when compared to group 1. However on subsequent follow up 8thweek and 12thweek pain severity was reduced in both the group and was almost similar. All the data from the study was evaluated by Student t test and ANOVA test with P value calculated in 2nd week, 4th week, 8th week and 12th week and out of which it was found to be statistically significant difference at end of 2nd, 4th and 8th week in both group, whereas at the end of 12th week there was not much statistically significant difference in both groups pain score.
Conclusion: In patients with plantar fasciitis, corticosteroid injection at site of maximal tenderness will relieves pain significantly but results are good for short duration pain relief that is up to 4 weeks after the injection. Where as in patients who continues to do stretching exercises are symptomatically better at end of 8th and 12th week of therapy. At end of 12th week both local steroid injection and Plantar fascia stretching exercise showed similar results in terms of pain relief
Key words: plantar fasciitis, corticosteroid injection, stretching exercises.

References

1. Roxas M. Plantar fasciitis- Diagnosis and therapeutic considerations. Altern Med Rev 2005; 10:83-93.
2. Young CC, Rutherford DS, Neidfeldt MW. Treatment of plantar fasciitis. Am Fam Physician 2001;63:467-74.
3. Puttaswamaiah R, Chandran P. Degenerative plantar fasciitis: A review of current concepts. Foot 2007;17:3-9.
4. Shazia A, Davinder P, Singh B. Plantar heel pain. Clin Focus Prim Care 2011; 5:128-33.
5. Powell M, Post WR, Keener J, Wearden S. Effective treatment of chronic plantar fasciitis with dorsiflexion night splints : a crossover prospective randomized outcome study. Foot Ankle Int 1998;19:10-18.
6. Probe RA, Baca M, Adams R, Preece C. Night splint treatment for plantar fasciitis. A prospective randomized study. Clin Orthop Relat Res 1999; 368:190-5.
7. Tatli YZ, Kapasi S. The real risks of steroid injection for plantar fasciitis, with a review of conservative therapies. Curr Rev Musculoskeletal Med 2009; 2:3-9.
8. Montififard M, Javdan M, Teimouri M. Comparative study of the therapeutic effects of corticosteroid injection accompanied by casting and heel pad in treatment of heel pain. JRMS 2008;13:175-80.
9. Kudo P, Dainty K, Clarfield M, Coughlin L, Lavoie P, Lebrun C. Randomized, placebo-controlled double-blind clinical trial evaluating the treatment of plantar fasciitis with an extracorporeal shockwave therapy device :a North American confirmatory study. J Orthop Res 2006;24:115-23.
10. Peerbooms JC, van Laar W, Faber F, Schuller HM, van der Hoeven H, Gosens T. Use of platelet rich plasma to treat plantar fasciitis: design of a multicentre randomized control trial. BMC Musculoskeletal Disorder 2010;11:69.
11. Kampa RJ, Connell DA. Treatment of tendinopathy: is there a role for Autologous whole blood and platelet rich plasma injection. Int J Clin Pract 2010;64:1813-23.
12. Porter D, Barrill E, Oneacre K, May BD. The effects of duration and frequency of Achliies tendon stretching on dorsiflexion and outcome in painful heel syndrome: a randomized, blinded, control study Foot Ankle Int 2002;23:619 24.
13. DiGiovanni et al.Tissue-Specific Plantar fascia Stretching exercises enhance outcomes in patients with chronic heel pain, a prospective randomize study. J Bone joint surg Am 2003;85: 1270-77.
14. Acevedo JI. Beskin JL. Complications of plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int 1998;19:91-7.
15. Sellman JR. Plantar fascia rupture associated with corticosteroid injection. Foot Ankle Int 1994;15:376-81.
16. Cleland JA et al. Manual physical therapy and exercise versus electrophysical agents and exercise in the management of plantar heel pain: a multicenter randomized clinical trial. J Orthop Sports Phys Ther 2009;39:573- 85.
17. Lee HS, Choi YR, Kim SW, Lee JY, Seo JH, Jeong JJ. Risk factors affecting chronic rupture of the plantar fascia. Foot Ankle Int 2014;35:258-63.
18. Landorf KB, Menz HB. Plantar heel pain and fasciitis. BMJ Clin Evid 2008;1111.
19. Leach R, Jones R, Silva T. Rupture of the plantar fascia in athletes. J Bone Joint Surg Am 1978;60:537-39.
20. Digiovanni BF et al. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two year follow-up. J Bone Joint Surg Am 2006: 8: 1775-81.
21. Frater C.et al. Bone Scintigraphy Predicts Outcome of steroid injection for plantar fasciitis. J Nucl Med 2006;47:1577-80.

How to Cite this article: Ethiraj P, Venkataraman S, Arun H.S , Salunke A. Plantar fasciitis management: A
comparative study between plantar fascia stretching exercises versus local corticosteroid injection. Journal of Karnataka Orthopaedic Association May – Aug 2019; 7(2): 17-21

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Management of multifactorial causes of Patellofemoral Instability in a 19 year old girl

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Volume 7 | Issue 2 | May – Aug 2019 | Page: 34-37 | Y Nishanth Shetty, George Jacob, Appu Benny Thomas, Jacob Varughese

Authors: Y Nishanth Shetty [1], George Jacob [1], Appu Benny Thomas [1], Jacob Varughese [1].

[1] Department of Orthopaedics, VPS Lakeshore hospital, NH-66 Bypass Near Police Station, Nettoor, Maradu, Ernakulam, Kerala 682040

Address of Correspondence
Dr. Y Nishanth Shetty,
M.S. (Ortho), VPS Lakeshore hospital, NH-66 Bypass Near Police Station, Nettoor, Maradu, Ernakulam, Kerala 682040
E-mail: ynshetty@gmail.com

Abstract

Background: Patellofemoral instability is a common cause of recurrent patellar dislocation in adolescent females and athletes. The various risk factors for this condition include generalised ligamentous laxity, abnormal lower limb alignment. abnormal patella and trochlear morphology. We report a case where we encountered multiple factors causing recurrent patellar instability and addressed each problem in a step by step surgical approach.
Case Report: A 19 year old female presented with 5 episodes of recurrent patella dislocation a year. On examination, she had a beighton score of 8/11,a positive J sign and apprehension test. Radiographic evaluation showed a laterally subluxed patella with trochlear dysplasia and patella alta. CT scan and MRI confirmed a dejour type 2 trochlear dysplasia with increased tibial tuberosity –trochlear Groove distance and a deficient medial patellofemoral ligament(MPFL). She underwent an MPFL reconstruction with deepening trochleoplasty and medialization of the tibial tubercle.
Conclusion: This case highlights the complex presentation of patellar instability and the need for careful clinical and radiographic evaluation, along with a step by step surgical correction f each problem. This is to prevent overdoing any one procedure while addressing a multi factorial pathology by a surgeon resulting in increased patellofemoral pressures but instead use multiple procedures to ensure efficient correction and good clinical result.
Keywords: Recurrent patellar dislocation, Patella instability, trochlear dysplasia, TT-TG distance, MPFL reconstruction, patellofemoral arthritis, trochleoplasty.

References

1. Arendt EA, Fithian DC, Cohen E. Current concepts of lateral patella dislocation. Clinics in Sports Medicine. 2002;21(3):499–519.
2. Petri M, Falck CV, Broese M, Liodakis E, Balcarek P, Niemeyer P, et al. Influence of rupture patterns of the medial patellofemoral ligament (MPFL) on the outcome after operative treatment of traumatic patellar dislocation. Knee Surgery, Sports Traumatology, Arthroscopy. 2012Sep;21(3):683–9.
3. Senavongse W, Amis AA. The effects of articular, retinacular, or muscular deficiencies on patellofemoral joint stability: a biomechanical study in vitro. The Journal of bone and joint surgery. British volume. 2005 Apr;87(4):577-82.
4. Colvin AC, West RV. Patellar instability .The Journal of bone and joint surgery. 2008 Dec 1;90(12):2751-62.
5. Guilbert S, Chassaing V, Radier C, Hulet C, Rémy F, Chouteau J, et al. Axial MRI index of patellar engagement: A new method to assess patellar instability. Orthopaedics & Traumatology: Surgery & Research. 2013;99(8).
6. Dejour D, Ferrua P, Ntagiopoulos P, Radier C, Hulet C, Rémy F, et al. The introduction of a new MRI index to evaluate sagittal patellofemoral engagement. Orthopaedics & Traumatology: Surgery & Research. 2013;99(8).
7. Diduch D, Laidlaw M. Current concepts in the management of patellar instability. Indian Journal of Orthopaedics. 2017;51(5):493
8. Beck P, Brown NA, Greis PE, Burks RT. Patellofemoral contact pressures and lateral patellar translation after medial patellofemoral ligament reconstruction. The American journal of sports medicine. 2007 Sep;35(9):1557-63.
9. Camp CL, Stuart MJ, Krych AJ, Levy BA, Bond JR, Collins MS, et al. CT and MRI Measurements of Tibial Tubercle–Trochlear Groove Distances Are Not Equivalent in Patients With Patellar Instability. The American Journal of Sports Medicine. 2013;41(8):1835–40.
10. Verdonk R, Jansegers E, Stuyts B. Trochleoplasty in dysplastic knee trochlea. Knee Surgery, Sports Traumatology, Arthroscopy. 2005Nov;13(7):529–33.
11. Reddy K, Reddy N. Trochleoplasty and medial patellofemoral ligament reconstruction for recurrent patellar dislocation. Indian Journal of Orthopaedics. 2012;46(2):242.
12. Dean CS, Chahla J, Cruz RS, Cram TR, Laprade RF. Patellofemoral Joint Reconstruction for Patellar Instability: Medial Patellofemoral Ligament Reconstruction, Trochleoplasty, and Tibial Tubercle Osteotomy. Arthroscopy Techniques. 2016;5(1).

How to Cite this article: Shetty Y N, Jacob G, Thomas A B, Varughese J. Management of multifactorial causes of Patellofemoral Instability in a 19 year old girl. Journal of Karnataka Orthopaedic Association May – Aug 2019; 7(2): 34-37.

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