From Editor’s Desk

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Volume 8 | Issue 1 | Jan – Feb 2020 | Page: 1 | Anil k. Bhat [1][2]

Authors: Anil k. Bhat [1][2].

[1] Editor in chief, Journal of Karnataka Orthopaedic Association
[2] Department of Orthopaedics, Kasturba Medical College, Manipal,
Karnataka, India

Address of Correspondence
Dr Anil .K Bhat ,
Associate Dean, Professor, Unit of Hand and Microsurgery,
Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India
Manipal Academy of Higher education
E-mail: anilkbhat@yahoo.com

From Editor’s Desk

Wishing all our KOA members a very Happy New Year. It gives us immense satisfaction to bring you a new issue of KOA Journal for the year 2020. We had an eventful year 2019 with two issues with a number of informative articles from our esteemed members. We would like to take this opportunity to express our sincere thanks to all our KOA members for their valuable support in submitting scientific articles which made this current issue possible.
The core aim of scientific writing is to communicate new and novel developments and justify existing regimes which adds on to progress in our orthopaedic field. Authors, reviewers and editors of scientific journals share a common responsibility for the quality of writing in original articles. [1] It is heartening to see an increase in the number of manuscripts being received from all over the state. Unfortunately, many of these papers are being rejected purely on technical grounds like grammar and syntax errors, poor quality images and illustrations.
All journals come with clear and standing instructions for the authors which ensure the quality of scientific articles and maintain the journal’s position and stature. [2] This attract authors with considerable experience and reputation. Hence it is vital for us to maintain a standard which is reflected in the language, title, layout, references as demonstrated in the instruction for authors. [3] This journal, which is the educational arm of the KOA, has a significant role in orthopaedic education in our state in a scientific language. Like all Journals, we follow a pattern of style which best suits our reader and helps in our objective of communicating novel information to our members and therefore it is necessary for authors to first read and understand our journal’s style and to follow the instructions for authors. [4] Our reviewers continue to point out on the lacklustre quality of writing which has a significant volume of technical and language errors in composition and style. Perhaps a major reason for this could be a lack of formal training in prose and style for scientific writing as it is not included in our current medical education curriculum. The authors can read a select few succinct instructions on scientific writings from literature as suggested [1-4].
The Editorial team hopes to receive thought provoking scientific work for future publications from our members and readers as we push our journal for wider acceptance not only from our members but also from our fellow brethren from other state and national orthopaedic associations.

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

Dr Anil .K Bhat
Chief Editor, JKOA
Associate Dean
Professor, Unit of Hand and Microsurgery
Department of Orthopaedics, KMC, Manipal academy of Higher education
Manipal, Karnataka, India.

References

1. Kotsis SV, Chung KC. A guide for writing in the scientific forum. Plast Reconstr Surg. 2010; 126: 1763–71.
2. Quaile A, Scarlat MM, Mavrogenis AF, Mauffrey C. International Orthopaedics – instructions for authors, English expression, style and rules. Int Orthop. November 2019, Volume 43, Issue 11, pp 2425-7.
3. Pakes GE. Writing manuscripts describing clinical trials: A guide for pharmacotherapeutic researchers. Ann Pharmacother.2001; 35: 770–779.
4. Derish P, Eastwood S. A clarity clinic for surgical writing. J Surg Res. 2008;147:50–58.

How to Cite this article: Bhat A K. From Editor’s Desk. Journal of Karnataka Orthopaedic Association. Jan-Feb 2020;8(1): 1.

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Rheumatoid Wrist and Hand

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Volume 8 | Issue 1 | Jan – Feb 2020 | Page: 34-38  | Ashwath Madhusudan Acharya, Anil Keshavamurthy Bhat

Authors: Ashwath Madhusudan Acharya [1], Anil Keshavamurthy Bhat [1]

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

Address of Correspondence
Dr. Anil Keshavamurthy Bhat,
Kasturba Medical College, Manipal. Karnataka.India.
E-mail:anilbhatortho@gmail.com

Abstract

Rheumatoid Hand disorders continues to be a major disability for patients with rheumatoid arthritis. The evolution of complex deformities, its diagnosis and management remains a challenge to most of the surgeons. This is an appraisal on the different options available at various stages of the disease.
Keywords: Rheumatoid hand, Button hole and Swan neck deformity, Synovitis, Tenosynovitis

References

1. Current Concepts in the Management of the Rheumatoid Hand. J Hand Surg Am. 2011 April; 36(4): 736–747.
2. Taleisnik J. Rheumatoid arthritis of the wrist. Hand Clin. 1989 May;5(2):257-78.
3. Feldon P, Terrono AL, Nalebuff EA, Millender LH. Rheumatoid Arthritis and Other Connective Tissue Diseases. In Green’s operative hand surgery 7th edition Ed. Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, Cohen MS. Philadelphia, PA : Elsevier, 2017, 1832- 1903.
4. Lau CS, Chia F, Asia Pacific League of Associations for Rheumatology et al. APLAR rheumatoid arthritis treatment recommendations. Int J Rheum Dis. 2015 Sep;18(7):685-713.
5. Smolen JS, Landewé R, Bijlsma J et al EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2016 update. Ann Rheum Dis. 2017 Jun;76(6):960-977.
6. Varache S, Narbonne V, Jousse-Joulin S et al. Is routine viral screening useful in patients with recent-onset polyarthritis of a duration of at least 6 weeks? Results from a nationwide longitudinal prospective cohort study. Arthritis Care Res. 2011; 63(11):1565-70.
7. Feldon P, Terrono AL, Nalebuff EA, Millender LH. Rheumatoid Arthritis and Other Connective Tissue Diseases. In Green’s operative hand surgery 7th edition Ed. Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH, Cohen MS. Philadelphia, PA : Elsevier, 2017, 1832- 1903.
8. Herren DB, Simmen BR. Hand Surgery. 1st Edition. Ed. Berger RA, Weiss APC. Lippincott Williams & Wilkins, 2004, 1213 – 40.
9. Taleisnik J. Rheumatoid arthritis of the wrist. Hand Clin. 1989 May;5(2):257-78.
10. Strickland JW, Dellacqua D. Rheumatoid Arthritis in the Hand and Digits. Hand Surgery. 1st Edition. Ed. Berger RA, Weiss APC. Lippincott Williams & Wilkins, 2004, 1241 – 81.

How to Cite this article: Acharya A M, Bhat A K | Rheumatoid Wrist and Hand | Journal Of Karnataka Orthopaedic Association | Jan-Feb 2020; 8(1): 34-38.

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Chronic Osteomyelitis of Proximal Tibia Due To A Retained Glove Piece: A Case Report

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Volume 8 | Issue 1 | Jan – Feb 2020 | Page: 30-33  | Sujayendra D M, Mahesh S Kulkarni, Aditya Mukadam, Sharath K Rao

Authors: Sujayendra D M [1], Mahesh S Kulkarni [1], Aditya Mukadam [1], Sharath K Rao [1]

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

Address of Correspondence
Dr. Sujayendra D M,
Kasturba Medical College, MAHE, Manipal, India.
E-mail: sujayendra16@gmail.com

Abstract

Introduction: The classic presentation of chronic osteomyelitis is characterized clinically by the presence of a draining sinus, and radiologically by sequestrum. Despite adequate treatment when the sinus fails to heal, one has to evaluate for its persistence. The presence of sequestrum and foreign body is one of the common causes for failure of the treatment. Except for one report, there are no described cases in the literature, where the surgeon’s glove piece has been left inside a bone and caused osteomyelitis. We are reporting a case of chronic osteomyelitis of tibia due to a retained glove piece following surgical management of proximal tibia fracture.
Case Report: A 36-year year-old male, with nil pre-morbid conditions, presented with complaints of discharging sinus from the anterior aspect of the proximal part of the left leg since for 2.5 years. He had undergone implant removal for sinus discharge following healed proximal tibial fracture which was managed with open reduction and internal fixation. Radiological evaluation revealed a cavity with sequestrum. During planned debridement and sequestrectomy, one surgical glove piece was as well retrieved from the cavity. Pseudomonas aeruginosa was isolated and he received appropriate antibiotic therapy. The patient after the procedure improved and during the last past one 1 year of follow-up, there is no recurrence of discharge and sinus has healed.
Conclusion: Chronic osteomyelitis is a debilitating condition. All precautions are to be taken to prevent osteomyelitis while performing orthopaedic surgeries, more so while dealing with closed fractures. A high index of suspicion of foreign body retention is suggested while evaluating these cases,.While while performing procedures that involve instrumentation with sharp objects, one must regularly inspect and if the need be, replace the gloves regularly.
Keywords: Chronic osteomyelitis, Foreign body, Glove perforation, Fracture complication, Non-healing sinus, Infection.

References

1. ParsonsB, StraussE. Surgical management of chronic osteomyelitis.Am J Surg2004;188:57-66.
2. Radcliffe G. Osteomyelitis: A historical and basic sciences review. Orthop Trauma 2015;29:243-52.
3. WalterG, KemmererM, KapplerC, HoffmannR. Treatment algorithms for chronic osteomyelitis.DtschArzteblInt2012;109:257-64.
4. GitelisS, BrebachGT. The treatment of chronic osteomyelitis with a biodegradable antibiotic-impregnated implant.J OrthopSurg (Hong Kong)2002;10:53-60.
5. CiampoliniJ, HardingKG. Pathophysiology of chronic bacterial osteomyelitis. Why do antibiotics fail so often?Postgrad Med J2000;76:479-83.
6. JohnstonBR, HaAY, KwanD. Surgical management of chronic wounds.R I Med J (2013)2016;99:30-3.
7. AgarwalA, AgarwalS. Retained foreign body masquerading as chronic osteomyelitis: A series of 3 cases and literature review.J ClinOrthop Trauma2019;10:816-21.
8. LiawF, MurrayO, TanYY, HemsT. Retained foreign body in a diabetic patient’s hand.Open Orthop J2018;12:203-7.
9. VidyadharaS, RaoSK. Thorn prick osteomyelitis of the foot in barefoot walkers: A report of four cases.J OrthopSurg (Hong Kong)2006;14:222-4.
10. ChandrashekaraCM, GeorgeMA, Al-MarboiBS. Neglected foreign body, the cause of navicular osteomyelitis in a paediatric foot: A case report.J Orthop Case Rep2013;3:26-9.
11. ChangHC, VerhoevenW, ChayWM. Rubber foreign bodies in puncture wounds of the foot in patients wearing rubber-soled shoes.Foot Ankle Int2001;22:409-14.
12. SidharthanS, MbakoAN. Pitfalls in diagnosis and problems in extraction of retained wooden foreign bodies in the foot.Foot Ankle Surg2010;16:e18-20.
13. SivakumarR, SinghiPK, ChidambaramM, SomashekarV, ThangamaniV. A sub-acute septic arthritis of the knee; a sequelae to thorn prick injury of patella: A case report.J Orthop Case Rep2016;6:100-3.
14. MeurerWJ. Radial artery pseudoaneurysm caused by occult retained glass from a hand laceration.PediatrEmerg Care2009;25:255-7.
15. SurovA, ThermannF, BehrmannC, SpielmannRP, KornhuberM. Late sequelae of retained foreign bodies after World War II missile injuries.Injury2012;43:1614-6.
16. Imoisili M, Bonwit A, Bulas D. Toothpick puncture injuries of the foot in children. Pediatr Infect Dis J 2004;23:80-2.
17. Sadat-AliM, MarwahS, al-HabdanI. Retained portion of latex glove during femoral nailing. Case report.Indian J Med Sci1996;50:308-9.
18. González-ReimersE, Trujillo-MederosA, OrdóñezAC, Arnay-da-la-RosaM. A case of calcaneal osteomyelitis from the prehispanic population of El Hierro (Canary Islands).Int J Paleopathol2015;8:36-41.
19. WebbLX, HolmanJ, deAraujo B, ZaccaroDJ, GordonES. Antibiotic resistance in staphylococci adherent to cortical bone.J Orthop Trauma1994;8:28-33.
20. RovereGD, MatternML. Hemidiaphysectomy to control chronic osteomyelitis.South Med J1978;71:874-7.
21. SchneiderT, RenneyJ, HaymanJ. Angiosarcoma occurring with chronic osteomyelitis and residual foreign material: Case report of a late World War II wound complication.Aust N Z J Surg1997;67:576-8.
22. AggarwalAN, KiniSG, AroraA, SinghAP, GuptaS, GulatiD. Rubber band syndrome-high accuracy of clinical diagnosis.J PediatrOrthop2010;30:e1-4.
23. MaffulliN, CapassoG, TestaV. Glove perforation in elective orthopedic surgery.ActaOrthopScand1989;60:565-6.
24. LakomkinN, CruzAI Jr., FabricantPD, GeorgiadisAG, LawrenceJT. Glove perforation in orthopaedics: Probability of tearing gloves during high-risk events in trauma surgery.J Orthop Trauma2018;32:474-9.
25. MisteliH, WeberWP, ReckS, RosenthalR, ZwahlenM, FueglistalerP, et al. Surgical glove perforation and the risk of surgical site infection.Arch Surg2009;144:553-8.
26. HarnossJC, ParteckeLI, HeideckeCD, HübnerNO, KramerA, AssadianO. Concentration of bacteria passing through puncture holes in surgical gloves.Am J Infect Control2010;38:154-8.
27. EidelmanM, BialikV, MillerY, KassisI. Plantar puncture wounds in children: Analysis of 80 hospitalized patients and late sequelae.Isr Med Assoc J2003;5:268-71.
28. ElBouchti I, AitEssi F, AbkariI, LatifiM, ElHassani S. Foreign body granuloma: A diagnosis not to forget.Case Rep Orthop2012;2012:439836.
29. DeSmet L. Metallosis mimicking osteomyelitis from a forearm plate retained for 50 years.ActaOrthopBelg2000;66:289-91.

How to Cite this article: Sujayendra D M, Kulkarni M , Aditya Mukadam A, Rao S | Chronic Osteomyelitis of Proximal Tibia Due To A Retained Glove Piece: A Case Report | Journal Of Karnataka Orthopaedic Association | Jan-Feb 2020; 8(1): 30-33.

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Pirogoff Amputation in Forefoot and Midfoot Crush Injury as Staged Procedure: A Case Report

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Volume 8 | Issue 1 | Jan – Feb 2020 | Page: 27-29  | Aradhana T Rathod, Preetham Nagaraj, Suresh Kumar G

Authors: Aradhana T Rathod [1], Preetham Nagaraj [1], Suresh Kumar G [1]

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

Address of Correspondence
Dr. Aradhana T Rathod,
Bangalore Medical College and Research Institute Bangalore, Karnataka, INDIA.
E-mail: aradhana.tr@gmail.com

Abstract

We present a case of crush injury of fore foot and mid foot due to run over by four-wheeler in a road traffic accident in a 63-year-old male patient. During the third sitting, Pirogoff amputation was performed using cannulated cancellous screws for tibiocalcaneal fusion. The wound had marginal necrosis on the 6thday and skin loss; hence, skin graft was planned, which was carried out on the 21st post-operative day. Follow-up visit at 6months shows minimal loss of limb length and satisfactory functional results in gait. He did not require any walking aid to walk for shorter distance. At 1-year follow-up visit, the patient developed discharging sinus and lysis around the screw site; hence, implant removal was done. Wound healing was delayed up to 4 weeks. The patient was put on weight relieving calipers till then. After the wound healed, the patient was asked to bear weight. It can be considered as the treatment of choice for foot injuries where forefoot and midfoot cannot be reconstructed. Delayed presentation with implant loosening should be considered.
Keywords: Cannulated cancellous screws, Crush injury, Tibiocalcaneal fusion, Skin graft.

References

1. PirogoffNI. Resection of bones and joints and amputations and disarticulations of joints. 1864.ClinOrthopRelat Res1991;266:3-11.
2. EinsiedelT, DieterichJ, KinzlL, GebhardF, SchmelzA. Lower limb salvage using Pirogoff ankle arthrodesis: Minimally invasive and effective fixation with the Ilizarov external ring fixator.Orthopade2008;37:143-52.
3. Oestern S, Trompetter R, Lippross S, Daniels M, Varoga D, Mailander P, et al. Pirogoff’s amputation after shotgun injury of the foot: A case report. Foot Ankle J 2008;1:1.
4. NatherA, WongKL, LimAS, ZhaowenNg D, HeyHW. The modified Pirogoff’s amputation in treating diabetic foot infections: Surgical technique and case series.Diabet Foot Ankle2014;5. DOI: 10.3402/dfa.v5.23354.
5.BueschgesM, MuehlbergerT, MaussKL, BruckJC, OttomannC. Pirogow’samputation: A modification of the operation method.AdvOrthop2013;2013:460792.
6. IpaktchiK, SeidlA, BanegasR, HakD, MauffreyC. Pirogoff amputation for a bilateral traumatic lower-extremity amputee: Indication and technique.Orthopedics2014;37:397-401.
7. TaniguchiA, TanakaY, KadonoK, InadaY, TakakuraY. Pirogoff ankle disarticulation as an option for ankle disarticulation.ClinOrthopRelat Res2003;414:322-8.
8. denBakker FM, HoltslagHR, vanden Brand JG. Pirogoff amputation for foot trauma: An unusual amputation level: A case report.J Bone Joint Surg Am2010;92:2462-5.
9. RijkenAM, RaaymakersEL. The modified Pirogoff amputation for traumatic partial foot amputations.Eur J Surg1995;161:237-40.
10. GessmannJ, CitakM, FehmerT, SchildhauerTA, SeyboldD. Ilizarov external frame technique for pirogoff amputations with ankle disarticulation and tibiocalcaneal fusion.Foot Ankle Int2013;34:856-64.

How to Cite this article: Aradhana T Rathod, Nagaraj P, Suresh Kumar G | Pirogoff Amputation in Forefoot and Midfoot Crush Injury as Staged Procedure: A Case Report.| Journal Of Karnataka Orthopaedic Association | Jan-Feb 2020; 8(1): 27-29

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Management of digital nerve gaps: By Tubulization Technique

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Volume 8 | Issue 1 | Jan – Feb 2020 | Page: 25-26  | Ashwath Acharya, Mukund Agrawal, Anil. K. Bhat

Authors: Ashwath Acharya [1], Mukund Agrawal [1], Anil. K. Bhat [1]

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

Address of Correspondence
Dr. Anil Bhat,
Kasturba Medical College, Manipal. Karnataka.India.
E-mail: anilbhatortho@gmail.com

Abstract

Digital nerve defects following open injuries in the hand has significant morbidity as it often leads to neuromas and sensory dysesthesias. Reconstruction of such defects with nerve grafts frequently results in donor site complications. A simple solution to bridge such defects is the use of the Tubulisation technique. We present a case report of two patients and discuss its benefits.
Key words: Digital nerve, nerve conduit, Tubulisation

References

1.Battiston B, Geuna S, Ferrero M, Tos P. Nerve repair by means of tubulization: literature review and personal clinical experience comparing biological and synthetic conduits for sensory nerve repair. Microsurgery 2005;25:258 –267.
2.Brunelli G, Battiston B, Vigasio A, Brunelli G, Marocolo D. Bridging nerve defects with combined skeletal muscle and vein conduits. Microsurgery 1993;14:247–251.
3. Strauch B. Use of nerve conduits in peripheral nerve repair. Hand Clin 2000;16:123–130.

How to Cite this article: Acharya A, Agrawal M, Bhat A | Management of digital nerve gaps: By Tubulization Technique | Journal Of Karnataka Orthopaedic Association | Jan-Feb 2020; 8(1): 25-26

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Haglund’s Excision: Our Novel Technique

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Volume 8 | Issue 1 | Jan – Feb 2020 | Page: 22-24  | Mohan Thadi, Prajwal P. Mane

Authors: Mohan Thadi [1], Prajwal P. Mane [2].

[1] Department Of Orthopaedics, Amrita Institute of Medical Sciences, Kochi, Kerala, India.
[2] Department Of Orthopaedics, Kastrurba Medical College, Manipal, Karnataka, India.

Address of Correspondence
Dr. Prajwal P Mane,
Kastrurba Medical College, Manipal, Karnataka, India.
E-mail: pjlmane@gmail.com

Abstract

Introduction: Haglund’s deformity is one of the commonly encountered entities in day-to-day clinical practice. Haglund’s deformity is a posterosuperior prominence of the calcaneal tuberosity, it is also known as pump bump or retrocalcaneal bursitis. People who do not respond to the conservative trial may need surgical excision. Partial calcaneal osteotomy is an accepted surgical treatment for Haglund’s deformity. This partial excision may predispose to tendoachilles rupture if intraoperatively, the tendoachilles is injured during the calcaneal osteotomy.
Materials and Methods: Here, we propose our technique of calcaneal osteotomy with the lateral approach minimizing the injury to tendoachilles and also the post-surgical clinical outcome in 28 patients and 30 feet. All the patients were followed up till 1 year of post-operative period and the clinical outcome was analyzed using ankle-hindfoot scale.
Results: The average pre-operative visual analog scale was noted to be 7/10 and the post-operative average visual analog was noted to be 3/10. The average pre-operative ankle-hindfoot scale was 66/100 and the average 1-year post-operative ankle-hindfoot scale was noted to be 87/100. Majority of the patients were asymptomatic at the end of 1 year and none had any post-operative complication.
Conclusion: Calcaneal osteotomy with lateral approach is an effective treatment for refractory Haglund’s deformity provided adequate surgical steps which are followed to minimize the failure rates and to improve the clinical outcomes.
Keywords: Ankle-hindfoot scale, Calcaneal osteotomy, Haglund’s deformity, Retrocalcaneal bursitis, Tendoachilles.

References

1. BaxterDE, ZingasC. The foot in running.J Am Acad Orthop Surg1995;3:136-45.
2. AndersonJA, SueroE, O’LoughlinPF, KennedyJG. Surgery for retrocalcaneal bursitis: A tendon-splitting versus a lateral approach.Clin Orthop Relat Res2008;466:1678-82.
3. McGarveyWC, PalumboRC, BaxterDE, LeibmanBD. Insertional Achilles tendinosis: Surgical treatment through a central tendon splitting approach.Foot Ankle Int2002;23:19-25.
4. AngermannP. Chronic retrocalcaneal bursitis treated by resection of the calcaneus.Foot Ankle1990;10:285-7.
5. GreenAH, HassMI, TubridySP, GoldbergMM, PerryJB. Calcaneal osteotomy for retrocalcaneal exostosis.Clin Podiatr Med Surg1991;8:659-65.
6. JonesDC, JamesSL. Partial calcaneal ostectomy for retrocalcaneal bursitis.Am J Sports Med1984;12:72-3.
7. PaukerM, KatzK, YosipovitchZ. Calcaneal ostectomy for haglund disease.J Foot Surg1992;31:588-9.
8. KolodziejP, GlissonRR, NunleyJA. Risk of avulsion of the Achilles tendon after partial excision for treatment of insertional tendonitis and haglund’s deformity: A biomechanical study.Foot Ankle Int1999;20:433-7.
9. SellaEJ, CaminearDS, McLarneyEA. Haglund’s syndrome.J Foot Ankle Surg1998;37:110-4.
10. NatarajanS, NarayananVL. Haglund deformity surgical resection by the lateral approach.Malays Orthop J2015;9:1-3.

How to Cite this article: Thadi M, Mane P P. | Haglund’s Excision: Our Novel Technique. | Journal Of Karnataka Orthopaedic Association | Jan-Feb 2020; 8(1): 22-24

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Measurement of rotator interval dimension using MRI and its significance in management of cases of shoulder instability

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Volume 8 | Issue 1 | Jan – Feb 2020 | Page: 18-21  | Gaurav Sen, Lokesh M Gowda, Vinay Kumaraswamy

Authors: Gaurav Sen [1], Lokesh M Gowda [2], Vinay Kumaraswamy [3].

[1] Department of Orthopaedics, Sanjay Gandhi Institute of Trauma & Orthopaedics, Banglore, Karnataka, India.
[2] Department of Orthopaedics, Kampegowda Institute of Medical Sciences, Bangalore, Karnataka, India.
[3] Department of Orthopaedics, Bangalore Medica; College & Research Institute, Bangalore, India.

Address of Correspondence
Dr. Gaurav Sen,
Sanjay Gandhi Institute of Trauma & Orthopaedics, Banglore, Karnataka, India.
Email:

Abstract

The rotator interval structures, including the biceps tendon, SGHL, and coracohumeral ligament, play an important role in static and dynamic glenohumeral stability in conjunction with the MGHL [12].
The importance of rotator interval in pathogenesis of shoulder instability is increasingly being studied and appreciated. Rotator interval enlargement is being increasingly recognized as a independent pathology in addition to the primary pathology of labral tear in cases of shoulder instability. Closure of the rotator interval is one of the treatment options in treatment of recurrent dislocation shoulder to improve the results of arthroscopic shoulder instability surgeries. However, the methods of assessment of rotator interval are only subjective and done intra-operatively only. There are no objective methods of measurement of rotator interval and very few can be done pre operatively. We report our experience of measurement of rotator interval dimensions using MRI in cases of shoulder instability and its comparison with relatively normal shoulder MRI. There have been similar studies using MR arthrography. Our intention was to determine whether rotator interval dimension is significantly more in cases of shoulder instability and weather it can be done with routine MRI and how does it correlate with other studies done using MR arthrography.
Key words: Coracohumeral ligament, rotator.

References

1) Fitzpatrick MJ, Powell SE, Tibone JE, Warren RF. The anatomy, pathology, and definitive treatment of rotator interval lesions: current concepts. Arthroscopy.2003;19 Suppl 1:70-9.
2) Griggs SM, Ahn A, Green A. Idiopathic adhesive capsulitis. A prospective functional outcome study of nonoperative treatment. J Bone Joint Surg Am 2000;82:1398-1407.
3) Massoud SN, Pearse EO, Levy O, Copeland SA. Operative management of the frozen shoulder in patients with diabetes. J Shoulder Elbow Surg 2002;11:609-613.
4) Mengiardi B, Pfirrmann CW, Gerber C, Hodler J, Zanetti M. Frozen shoulder: MR arthrographic findings. Radiology 2004; 233:486-492.
5) Kim KC, Rhee KJ, Shin HD. Adhesive capsulitis of the shoulder: Dimensions of the rotator interval measured with magnetic resonance arthrography. J Shoulder Elbow Surg 2009 18:437-442.
6) Jost B, Koch PP, Gerber C. Anatomy and functional aspects of the rotator interval. J Shoulder Elbow Surg 2000;9:336-341.
7) Boardman ND, Debski RE, Warner JJ, et al. Tensile properties of the superior glenohumeral and coracohumeral ligaments. J Shoulder Elbow Surg 1996;5:249-254.
8) Harryman DT II, Sidles JA, Harris SL, Matsen FA III. The role of the rotator interval capsule in passive motion and stability of the shoulder. J Bone Joint Surg Am 1992;74:53-66.
9) Nobuhara K, Ikeda H. Rotator interval lesion. Clin Orthop Relat Res 1987:44-50.10)
10) Harryman DT II, Sidles JA, Harris SL, Matsen FA III. The role of the rotator interval capsule in passive motion and stability of the shoulder. J Bone Joint Surg Am 1992;74:53-66.
11) Field LD, Warren RF, O’Brien SJ, Altchek DW, Wickiewicz TL. Isolated closure of rotator interval defects for shoulder instability. Am J Sports Med 1995;23:557-563.
12) Fitzpatrick MJ, Powell SE, Tibone JE, Warren RF. The anatomy, pathology, and definitive treatment of rotator interval lesions: Current concepts. Arthroscopy 2003;19: 70-79 (Suppl 1).
13) Griggs SM, Ahn A, Green A. Idiopathic adhesive capsulitis. A prospective functional outcome study of nonoperative treatment. J Bone Joint Surg Am 2000;82:1398-1407.
14) Massoud SN, Pearse EO, Levy O, Copeland SA. Operative management of the frozen shoulder in patients with diabetes. J Shoulder Elbow Surg 2002;11:609-613.
15) Mengiardi B, Pfirrmann CW, Gerber C, Hodler J, Zanetti M. Frozen shoulder: MR arthrographic findings. Radiology 2004; 233:486-492.
16) Kim KC, Rhee KJ, Shin HD. Adhesive capsulitis of the shoulder: Dimensions of the rotator interval measured with magnetic resonance arthrography. J Shoulder Elbow Surg 2009; 18:437-442.
17) Field LD, Warren RF, O’Brien SJ, Altchek DW, Wickiewicz TL. Isolated closure of rotator interval defects for shoulder instability. Am J Sports Med 1995;23:557-563.
18) Fitzpatrick MJ, Powell SE, Tibone JE, Warren RF. The anatomy, pathology, and definitive treatment of rotator in- terval lesions: Current concepts. Arthroscopy 2003;19: 70-79 (Suppl 1).

How to Cite this article: Sen G, Gowda L, Kumaraswamy V | Measurement of rotator interval dimension using MRI and its significance in management of cases of shoulder instability | Journal Of Karnataka Orthopaedic Association | Jan-Feb 2020; 8(1): 18-21.

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Medial malleolus fracture management- A comparative study between tension band wiring and cancellous screw fixation.

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Volume 8 | Issue 1 | Jan – Feb 2020 | Page: 14-17  | Sagar Venkataraman, Prabhu Ethiraj, Arun Heddur Shanthappa Naik, Sandesh Agarawal

Authors: Sagar Venkataraman [1], Prabhu Ethiraj [1], Arun Heddur Shanthappa Naik [1], Sandesh Agarawal [1].

[1] Department of Orthopaedics, Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER) Tamaka, Kolar Karnataka INDIA.

Address of Correspondence
Dr. Prabhu Ethiraj
Associate Professor,Orthopaedics
Sri Devaraj Urs Academy of Higher Education and Research (SDUAHER) Tamaka, Kolar Karnataka INDIA.
E-mail: prabhu.thepreacher@gmail.com

Abstract

Background: Medial malleolus fracture is commonly seen nowadays in orthopaedic practice. There are different modalities of treatment based on fracture pattern, socio-economic status. Undisplaced fracture can be managed by cast application. Various surgical modalities of treatment are available in treating medial malleolus fracture like tension band wiring, cancellous screw or cortical screw fixation, plate fixation, k-wire, suture anchors. The purpose of our study was to evaluate and compare radiological outcome of medial malleolar fracture managed with tension band wiring and cancellous screw fixation.
Materials and Methods: Our study included 53 patients who met inclusion criteria and were divided into two groups. 25 patients with bimalleolar fractures cases were included in group 1 and treated with open reduction and tension band wiring (TBW) for medial malleolus fracture. Other 28 patients in group 2 were treated by open reduction/closed reduction with cannulated cancellous screw for medial malleolus fracture. In all the cases lateral malleolus was fixed and common factor in both the group. All post op patients were evaluated at 1st month, 2nd month, 3rd month, 6th month and 1 year. We evaluated patient clinically and radiological union of fractures.
Results: In our study out of 53 patients there was male preponderance and average age was 42.07 years. Right side fractures were more compared to left side fractures. Most common mode of injury was road traffic accident. Average union time in group 1 is 14.4 weeks and group 2 is 12.6 weeks. Fracture union was 100% in group 1 and in group 2 was 96.66%. All the data from the study was evaluated by Fischer exact test with P value calculated for union rates between two groups patient treated with Tension Band Wiring Vs Cannulated cancellous screw. P value <0.05 was considered statistically significant.
Conclusion: In our study average union time in patients treated with cancellous screw fixation was early compared to patients treated with tension band wiring group. In cancellous screw fixation group required additional stability in the form additional k-wire or second cancellous screw with ankle joint immobilization.
Key words: Medial malleolus, Tension Band Wiring (TBW), Cancellous screw.

References

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6. Georgiadis GM, White DB. Modified tension band wiring of medial malleolar ankle fractures. Foot Ankle Int. ;1995:16(2):64-8.
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9. Wegner AM, Wolinsky PR, Robbins MA, Garcia TC, Maitra S, Amanatullah DF. Antiglide plating of vertical medial malleolus fractures provides stiffer initial fixation than bicortical or unicortical screw fixation. Clin Biomech (Bristol, Avon);2016;31(1):29-32.
10. David T, Loveday, Angus Arthur and Graham M. Tytherleigh-Strong. Technical Tip: Fixation of Medial Malleolar Fractures using a suture anchor. Foot Ankle Int; 2009;30(1):68.
11.Nurul SK, Shahidi P. Comparative study of malleolar fractures by tension band and malleolar screw. J Ortho Trauma 1998;12(1):13-9.
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How to Cite this article: Venkataraman S, Ethiraj P, Naik A, Agarawal S | Medial malleolus fracture management- A comparative study between tension band wiring and cancellous screw fixation. | Journal Of Karnataka Orthopaedic Association | Jan-Feb 2020; 8(1): 14-17.

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A cadaveric study on anatomical variations of the Sural nerve in the foot & ankle with relevance to surgical approaches

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Volume 8 | Issue 1 | Jan – Feb 2020 | Page: 9- 13  | Naganbhushan somayaji shiroor, Krishnaprasad P.R, Sandesh Madi, Mohandas Rao, Sapna Marpalli, Ashwini L SK

Authors: Naganbhushan somayaji shiroor [1], Krishnaprasad P.R [1], Sandesh Madi , Mohandas Rao [1],Sapna Marpalli [1], Ashwini L SK [1]

[1] Department of Orthopaedics, Kasturba Medical College,MAHE University, India.

Address of Correspondence

Dr. Krishnaprasad P.R,
Kasturba Medical College,MAHE University India.
E-mail: orthokrish@gmail.com

Abstract

Methods: Variations of the sural nerve were observed during the routine dissection of human cadavers. A total of 50 lower limbs were dissected and variations of sural nerve course, branching and distribution in the leg and foot were documented.
Results: On the basis of formation and course, the sural nerve in the back of the leg was divided into six types and in the foot into two types.
Conclusion: Awareness regarding the anatomical variations of the sural nerve becomes clinically relevant especially when Ankle is surgically approached posterolaterally for fixation of posterior malleolar fractures, high lateral malleolar fractures in pronation injuries of ankle and in foot, calcaneal fracture exposures in both classical extensile and sinius tarsi approach and in surgical exposure of talus both from medial and lateral exposures and for corrective osteotomies of calcaneum, Lisfranc fracture fixation and for various osteotomies of midfoot and forefoot.
Key words: Medial sural cutaneous nerve, Lateral sural cutaneous nerve, Anatomical variations, Cadver dissection, Foot and Ankle surgical approaches.

References

In our study, 4% (Two specimens) showed termination of sural nerve supplying the skin of adjacent sides of the third, fourth and fifth toes in addition to the lateral side of 5th toe.
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How to Cite this article: Shiroor A, Krishnaprasad P.R, Madi S, Rao M, Marpalli S, Ashwini L S | A cadaveric study on anatomical variations of the Sural nerve in the foot & ankle with relevance to surgical approaches | Journal Of Karnataka Orthopaedic Association | Jan-Feb 2020; 8(1):9-13.

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