The New Normal for Orthopaedic Surgeons

/0 Comments/in /by

Volume 8 | Issue 2 | Aug – Sep 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

The New Normal for Orthopaedic Surgeons

As things stand now, India is in third place in the world with more than 25 lakh cases of coronavirus infection with more than 50,000 deaths [1]. The good news is that we have a lower mortality rate compared to many other countries with respect to our population. This itself encourages us to come out of the shackles of lockdown to restart our lives with all the standard precautions and guidelines as prescribed by the Government and health authorities.

The role of Orthopaedic Surgeons in this situation has changed from speciality services to a front line worker. Injuries due to trauma had not stopped even in the lockdown period and Orthopaedic Surgeons had continued to render their services. With the increasing cases, they are now called to be part of the front line care, being deployed for COVID duties along with their peers in ICUs and COVID hospitals. This will be the new norm for many months to come.

The Indian scenario of health care services comprising medical institutions, corporate hospitals, smaller private setups and individual practice has thrown many challenges in health care delivery for patients with COVID infections and associated Orthopaedic pathologies. Each health care service has to create their protocols based on the infrastructure, man-power and expertise available. At the same time, restarting elective surgeries also is challenging for these establishments in their unique ways [2]. The requirements of COVID testing before surgery, the post-operative care and follow up of these patients with options for teleconsultations will be a part of a new practice system which have to be incorporated in our routine workflow. The guidelines are changing constantly as newer epidemiological, public health and health care delivery challenges emerge.
On the academic front, virtual conferences and Webinars are being undertaken with huge enthusiasm and we have to wait and see how much of these practices will hold good in the future. Postgraduates and Undergraduates teaching has entered a new paradigm of online classes but may not completely compensate for bedside teaching.
Rather than accepting the present situation as new normal and not processing the ravage of coronavirus, we need to look at the present situation as a new paradigm and take everyone along this process to emerge with minimal scars once this is pandemic is over.
The present volume of Journal comes in these tough times with dedicated teamwork at the Editorial office. We thank the Karnataka Orthopaedic Association office bearers & the KOA members for their constant support.

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. https://covid19india.org
2. Resuming Elective Orthopaedic Surgery During the COVID-19 Pandemic Guidelines Developed by the International Consensus Group (ICM), Parvizi, J.et al, The Journal of Bone and Joint Surgery: July 15, 2020 – Volume 102 – Issue 14 – p 1205-1212 DOI: 10.2106/JBJS.20.00844.

How to Cite this article: Bhat A K. The New Normal for Orthopaedic Surgeons. Journal of Karnataka Orthopaedic Association. Aug-Sep 2020;8(2): 1.

(Abstract    Full Text HTML)      (Download PDF)

Evaluation of Functional Outcome of Arthroscopic Meniscal Repair of Knee Joint

/0 Comments/in /by

Volume 8 | Issue 2   | Aug – Sep 2020 | Page: 28-33 | Darshan C K, Neelanagowda V Patil, Manohar Rao H R, Manjunath D N

Authors: Darshan C K [1], Neelanagowda V Patil [1], Manohar Rao H R [1], Manjunath D N [1]

[1] Department of Orthopaedics, Mysore Medical College and Research Institute, Mysore, Karnataka, India.

Address of Correspondence

Dr. Manohar Rao H R,
Mysore Medical College and Research Institute, Mysore, Karnataka, India .
E-mail: mandumanu@gmail.com

Abstract

Background: Knee joint is the largest and complex weight-bearing joint of the human body. The meniscus is a crescent-shaped fibrocartilaginous tissue in the knee joint. Meniscal tears are the most frequently encountered and treated injuries in the knee joint. This study aimed to evaluate the clinical and functional outcomes for a series of patients who underwent meniscal repair using all-inside technique for meniscal injuries.
Materials and Methods: All patients attended to the Department of Orthopaedics, Mysore Medical College and Research Institute, with peripheral meniscal tear operated by arthroscopic meniscal repair by all-inside technique and were evaluated for functional outcome using Lysholm score. Twenty-three cases of knee trauma diagnosed by clinical evaluation and magnetic resonance imaging were recruited for the study.
Results: A total of 23 subjects were included in the final analysis. The mean age was 32.39 ± 9.24 years in the study population. A significant portion (47.8%) of the study population belonged to 30–39 years age group. About 82.6% of the study participants were male. Among the study population, 11 (47.8%) participants had good functional outcome, and 12 (52.2%) participants had excellent functional outcome at 12 months. Among the 23 subjects, 8 (34.80%) had isolated meniscal tear, and 15 (65.20%) had either anterior cruciate ligament (ACL) or posterior cruciate ligament plus meniscal injury.
Conclusion: The study concluded that arthroscopic meniscal repair is a very effective method of treating meniscal injuries. It gave painless functional knee postoperatively with a good range of movements and increased quality of life. Patients with simultaneous ACL reconstruction had a better outcome than an isolated meniscal repair. However, the comparative statistical analysis could not be made with isolated meniscal repair due to a small study group. Our results were comparable with the various studies with respect to the Lysholm scoring and the outcome.
Keywords: Knee joint, Meniscal injuries, Arthroscopic meniscal repair.

References

1. Khan HA, Ahad H, Sharma P, Bajaj P, Hassan N, Kamal Y. Correlation between magnetic resonance imaging and arthroscopic findings in the knee joint. Trauma Monthly 2015;20:e18635.
2. Shimomura K, Hamamoto S, Hart DA, Yoshikawa H, Nakamura N. Meniscal repair and regeneration: Current strategies and future perspectives. J Clin Orthop Trauma 2018;9:247-53.
3. Allaire R, Muriuki M, Gilbertson L, Harner CD. Biomechanical consequences of a tear of the posterior root of the medial meniscus: Similar to total meniscectomy. J Bone Joint Surg Am 2008;90:1922-31.
4. Weber J, Koch M, Angele P, Zellner J. The role of meniscal repair for prevention of early onset of osteoarthritis. J Exp Orthop 2018;5:10.
5. Lysholm J, Gillquist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med 1982;10:150-4.
6. Tegner Y, Lysholm J. Rating systems in the evaluation of knee ligament injuries. Clin Orthop Relat Res 1985;198:43-9.
7. Briggs KK, Lysholm J, Tegner Y, Rodkey WG, Kocher MS, Steadman JR. The reliability, validity, and responsiveness of the lysholm score and tegner activity scale for anterior cruciate ligament injuries of the knee: 25 years later. Am J Sports Med 2009;37:890-7.
8. Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ. Reliability, validity, and responsiveness of the lysholm knee scale for various chondral disorders of the knee. J Bone Joint Surg Am 2004;86:1139-45.
9. Briggs KK, Kocher MS, Rodkey WG, Steadman JR. Reliability, validity, and responsiveness of the lysholm knee score and tegner activity scale for patients with meniscal injury of the knee. J Bone Joint Surg Am 2006;88:698-705.
10. Paxton EW, Fithian DC, Stone ML, Silva P. The reliability and validity of knee-specific and general health instruments in assessing acute patellar dislocation outcomes. Am J Sports Med 2003;31:487-92.
11. Eshuis R, Lentjes GW, Tegner Y, Wolterbeek N, Veen MR. Dutch translation and cross-cultural adaptation of the lysholm score and tegner activity scale for patients with anterior cruciate ligament injuries. J Orthop Sports Phys Ther 2016;46:976-83.
12. IBM Corp. Released IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp; 2013.
13. Patil SS, Shekhar A, Tapasvi SR. Meniscal preservation is important for the knee joint. Indian J Orthop 2017;51:576.
14. Cipolla M, Scala A, Gianni E, Puddu G. Different patterns of meniscal tears in acute anterior cruciate ligament (ACL) ruptures and in chronic ACL-deficient knees. Knee Surg Sports Traumatol Arthrosc 1995;3:130-4.
15. Nikolić DK. Lateral meniscal tears and their evolution in acute injuries of the anterior cruciate ligament of the knee arthroscopic analysis. Knee Surg Sports Traumatol Arthrosc 1998;6:26-30.
16. Al Saran Y, Al Lhaidan A, Al Garni N, Al Aqeel M, Alomar A. Patterns of meniscal damage associated with acute ACL rupture. J Orthopedics Rheumatol 2014;2:4.
17. Higuchi H, Kimura M, Shirakura K, Terauchi M, Takagishi K. Factors affecting long-term results after arthroscopic partial meniscectomy. Clin Orthop Relat Res 2000;377:161-8.
18. Eggli S, Wegmüller H, Kosina J, Huckell C, Jakob RP. Long-term results of arthroscopic meniscal repair: An analysis of isolated tears. Am J Sports Med 1995;23:715-20.
19. Johnson MJ, Lucas GL, Dusek JK, Henning CE. Isolated arthroscopic meniscal repair: A long-term outcome study (more than 10 years). Am J Sports Med 1999;27:44-9.
20. Majewski M, Stoll R, Widmer H, Müller W, Friederich NF. Midterm and long-term results after arthroscopic suture repair of isolated, longitudinal, vertical meniscal tears in stable knees. Am J Sports Med 2006;34:1072-6.
21. Nakayama H, Kanto R, Kambara S, Kurosaka K, Onishi S, Yoshiya S, et al. Clinical outcome of meniscus repair for isolated meniscus tear in athletes. Asia Pac J Sports Med Arthrosc Rehabil Technol 2017;10:4-7.
22. Pujol N, Tardy N, Boisrenoult P, Beaufils P. Long-term outcomes of all-inside meniscal repair. Knee Surg Sports Traumatol Arthrosc 2015;23:219-24.
23. Stein T, Mehling AP, Welsch F, von Eisenhart-Rothe R, Jäger A. Long-term outcome after arthroscopic meniscal repair versus arthroscopic partial meniscectomy for traumatic meniscal tears. Am J Sports Med 2010;38:1542-8.
24. Rothermel SD, Smuin D, Dhawan A. Are outcomes after meniscal repair age dependent? A systematic review. Arthroscopy 2018;34:979-87.
25. Vaquero-Picado A, Rodríguez-Merchán EC. Arthroscopic repair of the meniscus: Surgical management and clinical outcomes. EFORT Open Rev 2018;3:584-94.

How to Cite this article: Darshan CK, Patil NV, Rao HRM, Manjunath DN | Evaluation of Functional Outcome of Arthroscopic Meniscal Repair of Knee Joint | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 28-33.

                                          (Abstract    Full Text HTML)      (Download PDF)

Fractures of the Scapula: A Narrative Review on Diagnosis and Management

/0 Comments/in /by

Volume 8 | Issue 2 | Aug – Sep 2020 | Page: 53-59 | Sujayendra Murali, Sandesh Madi, Raghuraj Kundangar, Monappa Naik, Anika Sait

Authors: Sujayendra Murali [1], Sandesh Madi [1], Raghuraj Kundangar [1], Monappa Naik [1], Anika Sait [1]

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

Address of Correspondence
Dr.Sujayendra Murali
Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal -576104
E-mail: sujayendra16@gmail.com

Abstract

Scapula fractures are relatively rare when compared to fractures of the other bones of the shoulder region. High-velocity injuries encountered in road traffic accidents are responsible for the increased incidence of these fractures. Intra-thoracic and cervical spine injuries can be associated with these fractures and warrants a thorough clinical examination. In an acute setting of patient resuscitation, the initial diagnosis of these fractures is frequently missed or delayed. Radiological assessment should include dedicated shoulder trauma X-ray series and computed tomography scans with three-dimensional reconstruction. Being suspended by the dense muscles of the shoulder complex, the union of these fractures is rarely a concern. However, with a better understanding of the biomechanics, the management of these fractures is gradually evolving. Only in recent times, the criteria for surgical intervention for these fractures have been defined. This narrative review aims to provide a brief overview of the recent advances and the changing concepts of these uncommon fractures.
Key words: Trauma; Scapula; Fracture classification; glenoid; algorithm.

References

1. Cole PA, Freeman G, Dubin JR. Scapula fractures. Curr Rev Musculoskelet Med 2013;6:79-87.
2. Cole PA, Talbot M, Schroder LK, Anavian J. Extra-articular malunions of the scapula: A comparison of functional outcome before and after reconstruction. J Orthop Trauma 2011;25:649-56.
3. Hackney RG. Advances in the understanding of throwing injuries of the shoulder. Br J Sports Med 1996;30:282-8.
4. Myers JB, Riemann BL, Ju YY, Hwang JH, McMahon PJ, Lephart SM. Shoulder muscle reflex latencies under various levels of muscle contraction. Clin Orthop Relat Res 2003;407:92-101.
5. Goss TP. Double disruptions of the superior shoulder suspensory complex. J Orthop Trauma 1993;7:99-106.
6. DeFranco MJ, Patterson BM. The floating shoulder. J Am Acad Orthop Surg 2006;14:499-509.
7. Baldwin KD, Ohman-Strickland P, Mehta S, Hume E. Scapula fractures: A marker for concomitant injury? A retrospective review of data in the national trauma database. J Trauma 2008;65:430-5.
8. Mayo KA, Benirschke SK, Mast JW. Displaced fractures of the glenoid fossa. Results of open reduction and internal fixation. Clin Orthop Relat Res 1998;347:122-30.
9. Anavian J, Conflitti JM, Khanna G, Guthrie ST, Cole, PA. A reliable radiographic measurement technique for extra-articular scapular fractures. Clin Orthop Relat Res 2011;469:3371-8.
10. Koh KH, Han, KY, Yoon YC, Lee SW, Yoo JC. True anteroposterior (Grashey) view as a screening radiograph for further imaging study in rotator cuff tear. J Shoulder Elbow Surg 2013;22:901-7.
11. Tuček M, Naňka O, Malík J, Bartoníček J. The scapular glenopolar angle: Standard values and side differences. Skeletal Radiol 2014;43:1583-7.
12. McAdams TR, Blevins FT, Martin TP, DeCoster TA. The role of plain films and computed tomography in the evaluation of scapular neck fractures. J Orthop Trauma 2002;16:7-11.
13. Bartoníček J, Frič V. Scapular body fractures: Results of operative treatment. Int Orthop 2011;35:747-53.
14. Armitage BM, Wijdicks CA, Tarkin IS, Schroder LK, Marek DJ, Zlowodzki M, et al. Mapping of scapular fractures with three-dimensional computed tomography. J Bone Joint Surg Am 2009;91:2222-8.
15. Tadros AM, Lunsjo K, Czechowski J, Abu-Zidan FM. Multiple-region scapular fractures had more severe chest injury than single-region fractures: A prospective study of 107 blunt trauma patients. J Trauma 2007;63:889-93.
16. Bartonicek J, Klika D, Tucek M. Classification of scapular body fractures. Rozhl Chir 2018;97:67-76.
17. Nau T, Petras N, Vécsei V. Fractures of the scapula-classification and treatment principles. Osteosynth Trauma Care 2004;12:174-9.
18. Bigliani LU, Newton PM, Steinmann SP, Connor PM, Mcllveen SJ. Glenoid rim lesions associated with recurrent anterior dislocation of the shoulder. Am J Sports Med 1998;26:41-5.
19. Woolnough T, Shah A, Sheean AJ, Lesniak BP, Wong I, Sa D. Postage stamp fractures: A systematic review of patient and suture anchor profiles causing anterior glenoid rim fractures after bankart repair. Arthroscopy 2019;35:2501-8.e2.
20. Ada JR, Miller ME. Scapular fractures. Analysis of 113 cases. Clin Orthop Relat Res 1991;269:174-80.
21. Romero J, Schai P, Imhoff AB. Scapular neck fracture-the influence of permanent malalignment of the glenoid neck on clinical outcome. Arch Orthop Trauma Surg 2001;121:313-6.
22. Pace AM, Stuart R, Brownlow H. Outcome of glenoid neck fractures. J Shoulder Elbow Surg 2005;14:585-90.
23. Dimitroulias A, Molinero KG, Krenk DE, Muffly MT, Altman DT, Altman GT. Outcomes of nonoperatively treated displaced scapular body fractures. Clin Orthop Relat Res 2011;469:1459-65.
24. Jones CB, Sietsema DL. Analysis of operative versus nonoperative treatment of displaced scapular fractures. Clin Orthop Relat Res 2011;469:3379-89.
25. McGinnis M, Denton JR. Fractures of the scapula: A retrospective study of 40 fractured scapulae. J Trauma 1989;29:1488-93.
26. Wilber MC, Evans EB. Fractures of the scapula. An analysis of forty cases and a review of the literature. J Bone Joint Surg Am 1977;59:358-62.
27. Gramstad GD, Marra G. Treatment of glenoid fractures. Tech Shoulder Elb Surg 2002;3:102-10.
28. Cole PA, Gauger EM, Herrera DA, Anavian J, Tarkin IS. Radiographic follow-up of 84 operatively treated scapula neck and body fractures. Injury 2012;43:327-33.
29. Edwards SG, Whittle AP, Wood GW. Nonoperative treatment of ipsilateral fractures of the scapula and clavicle. J Bone Joint Surg Am 2000;82:774-80.
30. Williams GR, Naranja J, Klimkiewicz J, Karduna A, Iannotti JP, Ramsey M. The floating shoulder: A biomechanical basis for classification and management. J Bone Joint Surg Am 2001;83:1182-7.
31. Gardner MJ, Kelly BT, Lorich DG. Treatment of glenoid fractures and injuries to the superior shoulder suspensory complex. In: Dines DS, Lorich DG, Helfet DL, editors. Solutions for Complex Upper Extremity Trauma. New York: Thieme; 2008.
32. Ogawa K, Naniwa T. Fractures of the acromion and the lateral scapular spine. J Shoulder Elbow Surg 1997;6:544-8.
33. Ogawa K, Yoshida A, Takahashi M, Ui M. Fractures of the coracoid process. J Bone Joint Surg Br 1997;79:17-9.
34. Ogawa K, Matsumura N, Ikegami H. Coracoid fractures: Therapeutic strategy and surgical outcomes. J Trauma Acute Care Surg 2012;72:E20-6.
35. Eyres KS, Brooks A, Stanley D. Fractures of the coracoid process. J Bone Joint Surg Br 1995;77:425-8.
36. Goss TP. The scapula: Coracoid, acromial, and avulsion fractures. Am J Orthop (Belle Mead NJ) 1996;25:106-15.
37. Anavian J, Wijdicks CA, Schroder LK, Vang S, Cole PA. Surgery for scapula process fractures: Good outcome in 26 patients. Acta Orthop 2009;80:344-50.
38. Judet R. Traitement chirurgical des fractures de l’omoplate. Acta Orthop Belg 1964;30:673-8.
39. Van Oostveen DP, Temmerman OP, Burger BJ, Van Noort A, Robinson M. Glenoid fractures: A review of pathology, classification, treatment and results. Acta Orthop Belg 2014;80:88-98.
40. Avramidis G, Brilakis E, Deligeorgis A, Antonogiannakis E. All-arthroscopic treatment of glenoid rim fractures. Arthrosc Tech 2019;8:e1121-4.
41. Corradini A, Campochiaro G, Gialdini M, Rebuzzi M, Baudi P. Arthroscopic repair of glenoid rim fractures: A ligamentotaxis surgical technique. Musculoskelet Surg 2018;102 Suppl 1:41-8.
42. Maziak N, Minkus M, Krüger D, Scheibel M. Arthroscopic reconstruction of multifragmented anteroinferior glenoid rim fractures. JBJS Essent Surg Tech 2019;9:e36.1-6.
43. Bonnevialle N, Clavert P, Arboucalot M, Bahlau D, Bauer T, Ehlinger M, et al. Contribution of arthroscopy in the treatment of anterior glenoid rim fractures: A comparison with open surgery. J Shoulder Elbow Surg 2019;28:42-7.
44. Cole PA, Dugarte AJ. Posterior scapula approaches: Extensile and modified judet. J Orthop Trauma 2018;32 Suppl 1:S10-1.
45. Cole PA, Gauger EM, Schroder LK. Management of scapular fractures. J Am Acad Orthop Surg 2012;20:130-41.

How to Cite this article: Murali S, Madi S, Kundangar R, Naik M, Sait A | Fractures of the Scapula: A Narrative Review on Diagnosis and Management | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 53-59.

                                          (Abstract    Full Text HTML)      (Download PDF)

A Study to Know Short Term Outcome of Tricolumnar Plating in Complex Tibial Plateau Fractures

/0 Comments/in /by

Volume 8 | Issue 2   | Aug – Sep 2020 | Page: 2-6 | S. B Kamareddy, Pradeep Kumar Natikar, Mujtaba Hussain Patel

Authors: S. B Kamareddy [1], Pradeep Kumar Natikar [2], Mujtaba Hussain Patel [1,2]

[1] Kamareddy Ortho and Trauma Care Centre, Kalaburagi, Gulbarga, Karnataka, India.
[2] Department of Orthopaedics, KBNIMS Kalaburagi, Gulbarga, Karnataka, India.

Address of Correspondence
Dr. Pradeep Kumar Natikar,
KBNIMS Kalaburagi, Gulbarga, Karnataka, India.
E-mail: drpradeepnatikar@gmail.com

Abstract

Background: Tricolumnar plate fixation in comminuted proximal tibial fractures remains a new concept to have a rigid construct and to improve the functional outcome with dual incision. We performed a retrospective study to evaluate the functional outcome of proximal tibial fracture fixation using tricolumn plating.
Objective: The objective of the study was to study the clinical outcome of internal fixation with tricolumnar plating for the treatment of complex tibial plateau fractures.
Materials and Methods: The study was conducted in tertiary care center, Kalaburagi, over a period of 2 years from June 2017 to June 2019. Twenty patients with complex tibial plateau fractures were treated with tricolumnar plating through posteromedial and anterolateral approaches. There were 12 males and 8 females, with an average age of 45.2 years old (ranged, 32–60 years old). Fourteen patients had injuries in the left side and 6 patients had injuries in the right side. According to Schatzker classification, 14 patients were type V and 6 patients were type VI.
According to the three-column classification, all the patients had injuries of lateral, medial, and posterior columns. All the patients were evaluated using the Oxford Knee Score at 6-month and 1-year follow-up.
Results: The mean interval from injury to operation was 9.4 days (ranged, 6–15 days). The bone union time ranged from 4 to 10 months after operation. According to the results of Oxford Knee Score, 14 patients got an excellent result, 3 good, and 3 moderate.
Conclusion: Tricolumnar plate fixation for the treatment of complex tibial plateau fractures is effective to achieve anatomic reduction, rigid internal fixation, and good functional outcome. Careful soft-tissue handling and employing minimally invasive techniques minimize soft-tissue complications.
Key words: Tricolumnar plating, Schatzker classification, Oxford Knee Score.

References

1. Luo CF, Sun H, Zhang B, Zeng BF (2010) Three-column fixation for complex tibial plateau fractures. J Orthop Trauma 24(11):683–692. doi:10.1097/BOT.0b013e3181d436f3
2. Krieg JC. Proximal tibial fracture: current treatment, results, and problems. Injury. 2003;34:A2–A10.
3. Ricci WM, Rudzki JR, Borrelli J. Treatment of complex proximal tibia fractures with the less invasive skeletal stabilization system. J OrthopTrauma. 2004;18:521–527.
4. Carlson DA. Posterior bicondylar tibial plateau fractures. J Orthop Trauma. 2005;19:73–78.
5. Barei DP, Nork SE, Mills WJ, Complications associated with internal fixation of high-energy bicondylar tibial plateau fractures utilizing a two incision technique. J Orthop Trauma. 2004;18:649–657
6. Weil YA, Gardner MJ, Boraiah SB, Posteromedial supine approach for reduction and fixation of medial and bicondylar tibial plateau fractures. J Orthop Trauma. 2008;22: 357–62.
7. Barei DP, O’Mara TJ, Taitsman LA, Frequency and fracture morphology of the posteromedial fragment in bicondylar tibial plateau fracture patterns. J Orthop Trauma. 2008;22:176–82.
8. Luo CF, Jiang R, Hu CF, Medial double-plating for fracture dislocations involving the proximal tibia. Knee. 2006;13:389–94
9. Hackl W, Riedl J, Reichkendler M, Preoperative computerized tomography diagnosis of fractures of the tibial plateau. Unfallchirurg.2001;104:519–523
10. Wicky S, Blaser PF, Blanc CH, et al. Comparison between standardradiography and spiral CT with 3D reconstruction in the evaluation,classification and management of tibial plateau fractures. Eur Radiol.2000;10:1227–1232
11. Schatzker J, Tile M. The Rationale of Operative Fracture Care, 2nd ed.Berlin: Springer-Verlag; 1996:390–391.
12. Macarini L, Murrone M, Marini S, et al. Tibial plateau fractures:evaluation with multidetector-CT. Radiol Med. 2004;108:503–514.
13. Bhattacharyya T, McCarty LP 3rd, Harris MB, et al. The posterior shearing tibial plateau fracture: treatment and results via a posterior approach. J Orthop Trauma. 2005;19: 305–310.
14. Eggli et al. Unstable Bicondylar Tibial Plateau Fractures: A Clinical Investigation. J Orthop Trauma. 2008; 22: 673-679.
15. Su EP, Westrich GH, Rana AJ, Kapoor K, Helfet DL. Operative treatment of tibial plateau fractures in patients older than 55years. Clin Orthop Relat Res 2004;421: 240‑8
16. Barei DP, Nork SE, Mills WJ, Coles CP, Henley MB, BenirschkeSK. Functional outcomes of severe bicondylar tibial plateau fractures treated with dual incisions and medial and lateral plates. J Bone Joint Surg Am 2006;88: 1713‑21
17. Pelsar PM. Controversies in the management of tibial plateau fractures. SA Orthopaedic Journal. 2010, 75.
18. Zhang Y. Treatment of Complicated Tibial Plateau fractures with Dual Plating via 2 incision technique, Orthosupersite.com. 2012; 35:3.

How to Cite this article: Kamareddy SB, Natikar PK, Patel MH | A Study to Know Short Term Outcome of Tricolumnar Plating in Complex Tibial Plateau Fractures | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 2-6.

                                          (Abstract    Full Text HTML)      (Download PDF)

Study of Functional Outcome in Midshaft Clavicle Fracture Treated With Titanium Elastic Nailing System

/0 Comments/in /by

Volume 8 | Issue 2   | Aug – Sep 2020 | Page: 22-27 | Sreejith Thampy J, Arun H S, Prabhu E, Hariprasad S

Authors: Sreejith Thampy J [1], Arun H S [1], Prabhu E [1], Hariprasad S [1]

[1] Department of Orthopaedics, Sri Devaraj Urs Medical College, Kolar, Karnataka.

Address of Correspondence
Dr. Arun H S,
Department of Orthopaedics, Sri Devaraj Urs Medical College, Kolar, Karnataka.
E-mail: drarunhs5@gmail.com

Abstract

Purpose: Conservative methods were commonly used for midshaft clavicle fracture treatment, but with complications such as non-union, malunion, and shoulder asymmetry. Early surgical treatment for midshaft clavicular fractures could greatly reduce the same. Open reduction and internal fixation with plate and intramedullary fixation are the commonly used surgical techniques. Plating was considered as the gold standard in view of firm fixation and early rehabilitation, but with larger incision and soft-tissue exposure. Intramedullary fixation has been favored for its small incision, less periosteal striping, faster union, and less operating time. Here, we assess the functional outcome following titanium elastic nailing system (TENS) application.
Methodology: It is a prospective cohort study (evidence level II), 60 patients fitting as per inclusion and exclusion criteria presenting to our orthopedic department from July 2017 to May 2019 are included in the study after obtaining informed consent.
Results: Among 60 patients treated with TENS, excellent functional outcome was seen in 50 patients (83.3%) by the 3rd month and 54 (90%) by the 6th month using Constant and Murley scoring system. In our study, 66.6% of cases had union by the 3rd month and rest all by 6 months.
Conclusion: TENS should be considered as primary option for midshaft clavicle fracture with mild-to-moderate comminution.
Keywords: Midshaft clavicle fracture, Locking compression plate, Titanium elastic nailing system, Intramedullary nailing, Closed reduction and nailing, Mini-open incision.

References

1. Court-Brown CM, Heckman JD, McQueen MM, et al. Rockwood and Green’s Fractures in Adults. 8th ed. Philadelphia, PA: Wolters Kluwer; 2015. p. 1427-70.
2. Stanley D, Trowbridge EA, Norris SH. The mechanism of clavicular fracture. A clinical and biomechanical analysis. J Bone Joint Surg Br 1988;70:461-4.
3. Nowak J, Mallmin H, Larsson S. The aetiology and epidemiology of clavicular fractures. A prospective study during a 2-year period in Uppsala, Sweden. Injury 2000;31:353-8.
4. Schiffer G, Faymonville C, Skouras E, Andermahr J, Jubel A. Midclavicular fracture: Not just a trivial injury-current treatment options. Dtsch Arztebl Int 2010;107;711-7.
5. Neer CS. Nonunion of the clavicle. J Am Med Assoc 1960;172:1006-11.
6. Rowe CR. An atlas of anatomy and treatment of midclavicular fractures. Clin Orthop Relat Res 1968;58:29-42.
7. Canale ST, Beaty JH. Campbell’s Operative Orthopaedics. 11th ed. Philadelphia, PA: Elsevier; 2008. p. 3371-6.
8. Zlowodzki M, Zelle BA, Cole PA, Jeray K, McKee MD. Treatment of acute midshaft clavicle fractures: Systematic review of 2144 fractures: On behalf of the evidence-based orthopaedic trauma working group. J Orthop Trauma 2005;19:504-7.
9. University of Utrecht. (2017). Operative treatment of displaced clavicle fractures: optimising implant choice.
10. McKee MD, Wild LM, Schemitsch EH. Midshaft malunion of the clavicle. J Bone Joint Surg Am 2003;85:790-7.
11. Suhail AB, Khursheed AB, Sanjeev G, Lone MS, Bhat A, Ali N. Changing trends in management of adult clavicular fractures. IJAR 2014;6:843-9.
12. Kettler M, Schieker M, Braunstein V, König M, Mutschler W. Flexible intramedullary nailing for stabilization of displaced midshaft clavicle fractures: Technique and results in 87 patients. Acta Orthop 2007;78:424-9.
13. Constant CR, Murley AH. A clinical method of functional assessment of the shoulder. Clin Orthop Relat Res 1987;214:160-4.
14. Robinson CM, Brown CM, McQueen MM, Walkefield AE. Estimating the risk of non-union following non operative treatment of a clavicular fracture. J Bone Joint Surg Am 2004;86:1359-65.
15. Hill JM, McGuire MH, Crosby LA. Closed treatment of displaced middle third fractures of the clavicle gives poor results. J Bone Joint Surg Br 1997;79:537-40.
16. Nordgvist A, Petersson CJ, Redlund-Johnell I. Mid clavicular fractures in adults: End result study after conservative treatment. J Orthop Trauma 1998;12:572-6.
17. Guerra TE, Pozzi IM, Busin G, Zanetti LC, Lopes JA, Orso V. Densitometric study of the clavicle: Bone mineral density explains the laterality of the fractures. Rev Bras Ortop 2014;49:468-72.
18. Mueller M, Rangger C, Striepens N, Burger C. Minimally invasive intramedullary nailing of midshaft clavicular fractures using titanium elastic nails. J Trauma 2008;64:1528-34.
19. Slongo TF. Complications and failures of the ESIN technique. Injury 2005;36:78-85.
20. Zhang B, Zhu Y, Zhang F, Chen W, Tian Y, Zhang Y. Meta-analysis of plate fixation versus intramedullary fixation for the treatment of mid-shaft clavicle fractures. Scand J Trauma Resusc Emerg Med 2015;23:27.
21. Meier C, Grueninger P, Platz A. Elastic stable intramedullary nailing for midclavicular fractures in athletes: Indications, technical pitfalls and early results. Acta Orthop Belg 2006;72:269-75.

How to Cite this article: Thampy JS, Arun H S, Prabhu E, Hariprasad S | Study of Functional Outcome in Midshaft Clavicle Fracture Treated With Titanium Elastic Nailing System | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 22-27.

                                          (Abstract    Full Text HTML)      (Download PDF)

Progressive Post-traumatic Necrotizing Fasciitis in an Immunocompetent Adult Caused by Apophysomyces elegans

/0 Comments/in /by

Volume 8 | Issue 2 | Aug – Sep 2020 | Page: 49-52 | Manoh Shanmugam, Snolin Shiromi Antonyrajan

Authors: Manoh Shanmugam [1], Snolin Shiromi Antonyrajan [2]

[1] Consultant, Nallan Speciality Hospital, Madurai, Tamil Nadu.
[2] Department of Orthopaedics, Velammal Medical College Hospital and Research Institute

Address of Correspondence
Dr. Snolin Shiromi,
5, state bank officer’s I colony, S S Colony, Madurai, Tamil Nadu 625016, India
E-mail: snolinshiromi0@gmail.com

Abstract

A case of necrotizing fasciitis (NF) of the right upper limb caused by the fungi Apophysomyces elegans in an immunocompetent adult following polytrauma is reported. The probable portal of entry is abrasion with the environment being the source. Once clinically stable, the patient underwent surgical stabilization of fracture humerus and fracture clavicle. As the patient developed signs of NF in the right upper limb on the 14th post-operative day, empirical antibiotics were administered. Wound debridement was performed, and appropriate antibiotics were administered based on culture sensitivity. Since there was no clinical improvement, multiple wound debridements were performed. Amphotericin B was initiated empirically before the fungal culture report. As the wound was progressingly involving the whole limb, the patient ultimately required shoulder disarticulation. Containment of the infection with early initiation of amphotericin B and extensive wound debridements gave a positive outcome in our case. Mucormycosis should be considered a possibility in cases of NF with the progressive course and inadequate response to antibiotics.
Keywords: Necrotizing fasciitis, Amphotericin B, Mucormycosis, mucorales, Immunocompetent.

References

1. Puvanendran R, Huey JC, Pasupathy S. Necrotizing fasciitis. Can Fam Physician 2009;55:981-7.
2. Fontes RA Jr., Ogilvie CM, Miclau T. Necrotizing soft-tissue infections. J Am Acad Orthop Surg 2000;8:151-8.
3. Green RJ, Dafoe DC, Raffin TA. Necrotizing fasciitis. Chest 1996;110:219-29.
4. Sridhara SR, Paragache G, Panda NK, Chakrabarti A. Mucormycosis in immunocompetent individuals: An increasing trend. J Otolaryngol 2005;34:402-6.
5. Frater JL, Hall GS, Procop GW. Histologic features of zygomycosis: Emphasis on perineural invasion and fungal morphology. Arch Pathol Lab Med 2001;125:375-8.
6. Gomes ZR, Lewis RE, Kontoyiannis DP. Mucormycosis caused by unusual mucormycetes, Non-Rhizopus, -Mucor, and-Lichtheimia species Marisa. Clin Microbiol Rev 2011;24:411-45.
7. Kordy FN, Al-Mohsen IZ, Hashem F, Almodovar E, Al Hajjar S, Walsh TJ. Successful treatment of a child with posttraumatic necrotizing fasciitis caused by Apophysomyces elegans: Case report and review of literature. Pediatr Infect Dis J 2004;23:877-
8. Chakrabarti A, Chatterjee SS, Das A, Panda N, Shivaprakash MR, Kaur A, et al. Invasive zygomycosis in India: Experience in a tertiary care hospital. Postgrad Med J 2009;85:573-81.
9. Chander J, Stchigel AM, Alastruey-Izquierdo A, Jayant M, Bala K, Rani H, et al. Fungal necrotizing fasciitis, an emerging infectious disease caused by Apophysomyces (Mucorales). Rev Iberoam Micol 2015;32:93-8.
10. Mathews MS, Raman A, Nair A. Nosocomial zygomycotic post-surgical necrotizing fasciitis in a healthy adult caused by Apophysomyces elegans in South India. J Med Vet Mycol 1997;35:61-3.
11. Wang J, Harvey CM, Calhoun JH, Yin LY, Mader JT. Systemic Apophysomyces elegans after trauma: Case report and literature review. Surg Infect (Larchmt) 2002;3:283-9.
12. Chakrabarti A, Ghosh A, Prasad GS, David JK, Gupta S, Das A, et al. Apophysomyces elegans: An emerging zygomycete in India. J Clin Microbiol 2003;41:783-8.
13. Lakshmi V, Rani TS, Sharma S, Mohan VS, Sundaram C, Rao RR, et al. Zygomycotic necrotizing fasciitis caused by Apophysomyces elegans. J Clin Microbiol 1993;31:1368-9.
14. Chakrabarti A, Das A, Sharma A, Panda N, Das S, Gupta KL, et al. Ten years’ experience in zygomycosis at a tertiary care Centre in India. J Infect 2001;42:261-6.
15. Cáceres AM, Sardiñas C, Marcano C, Guevara R, Barros J, Bianchi G, et al. Apophysomyces elegans Limb infection with a favorable outcome: Case report and review. Clin Infect Dis 1997;25:331-2.
16. Wieden MA, Steinbronn KK, Padhye AA, Ajello L, Chandler FW. Zygomycosis caused by Apophysomyces elegans. J Clin Microbiol 1985;22:522-6.

How to Cite this article: Shanmugam M, Antonyrajan SS | Progressive Post-traumatic Necrotizing Fasciitis in an Immunocompetent Adult Caused by Apophysomyces elegans | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 49-52.

                                          (Abstract    Full Text HTML)      (Download PDF)

Comparing the Efficacy of Short-segment Transpedicular Stabilization with and without Intermediate Screw for Unstable Thoracolumbar Fractures

/0 Comments/in /by

Volume 8 | Issue 2   | Aug – Sep 2020 | Page: 16-21 | Mohan N S, Shankaragouda R Patil, Avinash Parthasarathy

Authors: Mohan N S [1], Shankaragouda R Patil [1], Avinash Parthasarathy [1]

[1] Department of Spine, Sanjay Gandhi institute of Trauma and Orthopaedics, Jayanagar East, Bangalore, India.

Address of Correspondence
Dr. Avinash Parthasarathy,
Dept. of Orthopaedics, Sanjay Gandhi institute of Trauma and Orthopaedics,
Jayanagar East, Bangalore 560011,Karnataka,India.
E-mail: dravinash.ortho@gmail.com

Abstract

Objectives: Clinical outcome of thoracolumbar unstable fracture treated by short-segment transpedicular fixation with and without intermediate screw fixation assessed by modified Macnab criteria, visual analog scale (VAS), and Oswestry Disability Index (ODI) and to compare the radiological outcome using Cobb angle, Beck index, and kyphotic deformation.
Methods: A prospective study of 60 patients with unstable thoracolumbar fracture was treated with posterior transpedicular screw fixation at Spine injury Centre, Sanjay Gandhi Institute of Trauma and Orthopaedics, Bengaluru, from December 2016 to July 2019. Clinical assessment was done using Macnab criteria, ODI, and VAS scoring system and radiological assessment was done using Cobb angle, becks index, and segmental kyphotic deformation. The patients were divided into two groups according to the surgical method used. In Group A, 28 patients underwent surgery with a posterior approach through transpedicular screw instrumentation with an additional screw at the fractured vertebrae. In Group B, 32 patients were received a traditional short-segment fixation (1 level above and 1 level below the fractured level). Clinical and radiologic parameters were evaluated before surgery and at 3 and 6 months and 1 year after surgery.
Results: Our study showed predominant male population (80%) of working age group (21–40 years), who had unstable thoracolumbar fractures. The most common mode of injury was fall from height (60%). Majority of the patients had L1 vertebra fracture of about 48% and 28% of T12 vertebra fracture. According to modified Macnab criteria, majority have good results at 3, 6, and 12 months of follow-up, at the end of 12 months, both groups have 50% and 68% good result and 50% and 28% of excellent results, respectively, but non-significant. Mean ODI after 1 year of follow-up shows 6.93 and 8.53 and VAS score at the end of 12th month of follow-up is 1.21 and 1.22, respectively. Both groups have better Cobb angle correction from 18.39° to 10.29° in Group A and 19.25° to 11.38° in Group B. Loss of Cobb angle correction is 2.97 Group A and 2.91 in Group B. Our study shows that there is no statistically significant improvement in Beck index in both groups from 0.64 to 0.78 in Group A and in Group B from 0.62 to 0.78. Both groups have better kyphotic deformation correction from 15.71° to 7.93° in Group A and 15.22° to 8.41° in Group B and it shows that Group A has more correction of kyphotic deformation.
Conclusions: Pedicle screw placement into the fractured vertebra in management of unstable thoracolumbar is safe and feasible. Pre-operative evaluation of pedicle dimension would be useful for the placement into fractured vertebra. Short-term benefits of placing pedicle screw into fractured vertebra are restoration of vertebral body height and kyphotic angle and indirect canal decompression.
Keywords: Thoracolumbar fracture, Short segment, Cobb angle, Transpedicular fixation, Kyphotic deformation, Additional screw, Burst fracture.

References

1. Ravikanth M, Babu TV, Chandrasekaran A. Comparison between short and long segment transpedicular fixation of thoracolumbar burst fractures. J Evid Based Med Healthc 2016;3:996-1001.
2. Joaquim AF, Patel AA. Thoracolumbar spine trauma: Evaluation and surgical decision-making. J Craniovertebr Junction Spine 2013;4:3-9.
3. Tiryaki M, Gergin YE, Kendirlioglu BC, DEMIR H, Çine HS. Thoracolumbar fractures: Should they be operated according to thoracolumbar injury classification and severity score (TLICS). J Turk Spinal Surg 2016;27:153-8.
4. Ozdogan S, Ozturk E, Altunrende ME, Savrunlu EC, Navruz Y, Çetin E, et al. Traumatic thoracolumbar fractures: Analysis of clinical series. J Turk Spinal Surg 2016;27:225-8.
5. Siebenga J, Leferink VJ, Segers MJ, Elzinga MJ, Bakker FC, Haarman HJ, et al. Treatment of traumatic thoracolumbar spine fractures: A multicenter prospective randomized study of operative versus nonsurgical treatment. Spine 2006;31:2881-90.
6. Alanay A, Acaroglu E, Yazici M, Oznur A, Surat A. Short-segment pedicle instrumentation of thoracolumbar burst fractures: Does transpedicular intracorporeal grafting prevent early failure? Spine (Phila Pa 1976) 2001;26:213-7.
7. Cho DY, Lee WY, Sheu PC. Treatment of thoracolumbar burst fractures with polymethyl methacrylate vertebroplasty and short-segment pedicle screw fixation. Neurosurgery 2003;53:1354-61.
8. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 1983;8:817-31.
9. Mahar A, Kim C, Wedemeyer M, Mitsunaga L, Odell T, Johnson B, et al Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976) 2007;32:1503-7.
10. Müller U, Berlemann U, Sledge J, Schwarzenbach O. Treatment of thoracolumbar burst fractures without neurologic deficit by indirect reduction and posterior instrumentation: Bisegmental stabilization with monosegmental fusion. Eur Spine J 1999;8:284-9.
11. Payer M. Unstable burst fractures of the thoraco-lumbar junction: Treatment by posterior bisegmental correction/fixation and staged anterior corpectomy and titanium cage implantation. Acta Neurochir (Wien) 2006;148:299-306.
12. Yang M, Wang X, Li J, Xiong G, Lu C, Lu G. Implanting pedicle screw in fractured vertebra results in no adverse effect on bone healing in thoracic or lumbar burst fracture. Turk Neurosurg 2013;23:778-82.
13. Eno JJ, Chen JL, Mitsunaga MM. Short same-segment fixation of thoracolumbar burst fractures. Hawaii J Med Public Health 2012;71:19-22.
14. Gurwitz GS, Dawson JM, McNamara MJ, Federspiel CF, Spengler DM. Biomechanical analysis of three surgical approaches for lumbar burst fractures using short-segment instrumentation. Spine 1993;18:977-82.
15. Guven O, Kocaoglu B, Bezer M, Aydin N, Nalbantoglu U. The use of screw at the fracture level in the treatment of thoracolumbar burst fractures. J Spinal Disord Tech 2009;22:417-21.
16. Defino HL, Scarparo P. Fractures of thoracolumbar spine: Monosegmental fixation. Injury 2005;36 Suppl 2:B90-7.
17. Lehman RA Jr., Lenke LG, Keeker KA, Kim YJ, Cheh G. Computed tomography evaluation of pedicle screws placed in the pediatric deformed spine over an 8-year period. Spine 2007;32:2679-84.
18. Gaines RW Jr. The use of pedicle-screw internal fixation for the operative treatment of spinal disorders. J Bone Jiont Surg Am 2000;82:1458-76.
19. Ye C, Luo Z, Yu X, Liu H, Zhang B, Dai M. Comparing the efficacy of short-segment pedicle screw instrumentation with and without intermediate screws for treating unstable thoracolumbar fractures. Medicine (Baltimore) 2017;96:e7893.
20. Huang W, Luo T. Efficacy analysis of pedicle screw internal fixation of fractured vertebrae in the treatment of thoracolumbar fractures. Exp Ther Med 2013;5:678-82.
21. Yu SW, Fang KF, Tseng IC, Chiu YL, Chen YJ, Chen WJ. Surgical outcomes of short-segment fixation for thoracolumbar fracture dislocation. Chang Gung Med J 2002;25:253-9.

How to Cite this article: Mohan N S, Patil SR, Parthasarathy A | Comparing the Efficacy of Short-segment Transpedicular Stabilization with and without Intermediate Screw for Unstable Thoracolumbar Fractures | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 16-21.

                                          (Abstract    Full Text HTML)      (Download PDF)

Acute Paraparesis Secondary to Epidural Hematoma Caused by Spinal Anesthesia Given for Lower Segment Caesarean Section

/0 Comments/in /by

Volume 8 | Issue 2 | Aug – Sep 2020 | Page: 46-48 | Uday Kumar Guled

Authors: Uday Kumar Guled [1]

[1] Department of Orthopaedics, S Nijalingappa Medical College ,Bagalkot, Karnataka, India.

Address of Correspondence
Dr. Udaykumar Guled
Assistant professor , S Nijalingappa Medical College ,Bagalkot, Karnataka, India.
E-mail: DRUDAYGULED@GMAIL.COM

Abstract

Spinal anesthesia is one of the most common anesthetic procedure performed in operative cases . Neurological deficit is an uncommon but catastrophic complication of spinal anesthesia. Epidural hematoma is the most common cause of such neurological deficit. Unidentified bleeding and clotting disorders increase the risk. On detection such complications need close monitoring. Though many cases can be managed conservatively, progressive deficit warrants quick decompression of spinal canal.
Keywords: Epidural hematoma, Paraparesis, Spinal anesthesia, Laminectomy.

References

1. Vandam. On the origins of intrathecal anaethesia. Int Anaesthesiol Clin 1989; 27: 2-7.
2. Kreppel D, Antoniadis G, Seeling W. Spinal hematoma: a literature survey with meta-analysis of 613 patients. Neurosurg Rev 2003;26:1-49
3. Berges PU. Regional anaesthesia for obstetrics. Clincanaesth 1969: 2; 141
4. Brown MW, Yilmaz TS, Kasper EM. Iatrogenic spinal hematoma as a complication of lumbar puncture: What is the risk and best management plan? SurgNeurol Int. 2016 Aug 29;7(Suppl 22):S581-9.
5. A, Yu A, Kaminski A. Anesthetic Complications in Pregnancy. Critical Care Clinic. 2016 Jan;32(1):1-28.
6. Ruppen W, Derry S, Mcquay H, Moore RA. Incidence of epidural hematoma, infection, amd neurologic injury in obstetric patients with epidural analgesia/ anesthesia. Anesthesiology2006;105:394-9
7. Guffey PJ, Mckay WR, Mckay RE. Epidural hematoma nine daysafter removal of a labor epidural catheter. AnesthAnalg2010;111:992-5
8. Tailor J, Dunn IF, Smith E. Conservative treatment of spontaneous spinal epidural hematoma associated with oral anticoagulant therapy in a child. Childs Nerv Syst 2006; 22: 1643-5.
9. Silber SH. Complete nonsurgical resolution of a spontaneous spinal epidural hematoma. Am J Emerg Med 1996; 14: 391-3.

How to Cite this article: Guled U K| Acute Paraparesis Secondary to Epidural Hematoma Caused by Spinal Anesthesia Given for Lower Segment Caesarean Section | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 46-48.

                                          (Abstract    Full Text HTML)      (Download PDF)

Study of Functional and Radiological Outcome of Short-Segment Pedicle Screw Fixation for Thoracolumbar Fractures with use of Pedicle Screws in Fractured Vertebrae

/0 Comments/in /by

Volume 8 | Issue 2   | Aug – Sep 2020 | Page: 7-15 | Mrinal B Shetty, Vinayak Venugopal, Jabez Gnany

Authors: Mrinal B Shetty [1], Vinayak Venugopal [1], Jabez Gnany [1]

[1] Department of Orthopaedics, Father Muller Medical College, Kankanady, Mangalore, Karnataka

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

Abstract

Purpose: The treatment of fracture-dislocations and unstable fractures of the thoracic and lumbar spine has been controversial. Many authors have advised conservative treatment which was labor intensive and associated with complications, increased bed occupancy, increased cost of therapy, increased hospital stay hours, and care by trained personnel. Early surgical indirect decompression with instrumentation reduces the duration of hospital stay, facilitates early recovery, and prevents prolonged morbidity, so there is an urgent need for possibilities of surgical stabilization, early mobilization, and rehabilitation of patients. The surgical decompression can be done anteriorly, posteriorly, or anteroposteriorly. With advent of pedicle screws, more and more fractures are treated with posterior based surgeries with long-segment (LS) fixation which regains spinal alignment and provides adequate stability. Short-segment pedicle screw fixations of thoracolumbar fractures excluding screw fixation at the fractured vertebrae do not provide the necessary stability; hence, additional fixation point with screws in the fractured vertebrae is useful and a safe technique in the treatment of thoracolumbar fractures.
This prospective study aims at comparing the clinical, radiological, and neurological outcomes after surgical decompression and instrumentation by posterior and transpedicular approach in thoracolumbar spinal fractures postoperatively at 1month, 6 months, and 1 year follow-up periods.
Materials and Methods: Adult patients with acute thoracolumbar injuries admitted to Spine Surgery unit, Father Muller Medical Hospital, Mangalore, were taken for this study after obtaining their informed, valid written consent. This is a prospective study from September 2016 to August 2018.
Results: In our study, 50% of population belong to the age group of 31–50 years, 28% belong to the age below 30 years, and 22% belong to the age above 50 years and 92% of population were male and the rest 8% were female. Twenty-nine of them sustained L1 flexion distraction injury which accounts to about 58% of the fracture, the second most common being six patients with D12 flexion distraction injury which accountsfor10% of cases. Three cases each of D11, L2, and L3 flexion distraction injury which accounts for 6% of fracture. One each case of D11 unstable burst fracture, D12 chance fracture, D12 unstable burst fracture,L1 unstable burst fracture, L1 chance fracture, and L3 unstable burst fracture which accounts for 2% of total fractures. Thirty-eight patients had no neurological deficits and categorized under the American Spine Injury Association (ASIA)-E which accounts for 76% of the cases. Seven had neurological deficits, incomplete categorized under ASIA-C which accounts for14% of the cases. Five were categorized under ASIA-D which accounts for 10% of total cases. Preoperatively, an average of 40.09% of vertebral body height was lost which improved in immediate post-operative period to 70.25% and maintained at 70.38% at the end of 1 year. Degree of segmental kyphosis preoperatively was 15.32°, which improved to 6.62° at the end of 1 year. Percentage of canal compromise measurement preoperatively showed an average of 30.38% of spinal canal encroachment. Immediate post-operative assessment showed decompression of canal to 12.64% and 10.00% at the end of 1 year. Preoperatively, an average Oswestry Disability Index score was 44.28% which improved inimmediate post-operative period to 32.52% and15.71% at the end of 1 year which is mildlevel of disability. Preoperatively, average visual analog score was 7 which shows moderate-to-severe pain which improved to 2.92, indicating minimal or no pain at the end of follow-up.
Conclusion: The technique of short-segment pedicle screw fixation with screws in fractured vertebrae is safe as our study did not show worsening of the pre-operative neurological status in any patients with ASIA-C and above. There was adequate indirect decompression of the spinal canal using smaller incision, resulting in lesser operative time, and blood loss. The vertebral body height was satisfactorily reconstructed, kyphotic angle reduced, and the spinal alignment was maintained. The final outcome in terms of improvement of ASIA impairment scale was determined by the initial injury. Incomplete injuries improved by at least one scale as per ASIA. Hence, this is an effective and safe technique which retains the biomechanical stability as compared to the LS fixation while requiring smaller incision, lesser operative time, and less blood loss.
Keywords: Short-segment pedicle screw fixation, Thoracolumbar fracture, Tanspedicular instrumentation.

References

1. Gertzbein SD. Scoliosis research society. Multicenter spine fracture study. Spine (Phila Pa 1976) 1992;17:528-40.
2. DeWald RL. Burst fractures of the thoracic and lumbar spine. ClinOrthop Res 1984;18:150-61.
3. Soreff J. Assesment of the Result of Traumatic Compression Fractures of the Thoraco-Lumbar Vertebral Bodies. Sweden: Stokhalm, Karoinska Hospital; 1975. p. 27
4. Azam MQ, Sadat-Ali M. The concept of evolution of thoracolumbar fracture classifications helps in surgical decisions. Asian Spine J 2015;9:984-94.
5. Gelb D, Ludwig S, Karp JE, Chung EH, Werner C, Kim T, et al. Successful treatment of thoracolumbar fractures with short-segment pedicle instrumentation. J Spinal Disord Tech 2010;23:293-301.
6. Mclain RF. The biomechanics of long versus short fixation for thoracolumbar spine fractures. Spine(Phila Pa 1976) 2006;31:70-9.
7. Mahar A, Kim C, Wedemeyer M, Mitsunaga L, Odell T, Johnson B, et al. Short-segment fixation of lumbar burst fractures using pedicle fixation at the level of the fracture. Spine (Phila Pa 1976) 2007;32:1503-7.
8. Guven O, Kocaoglu B, Bezer M, Aydin N, Nalbantoglu U. The use of screw at the fracture level in the treatment of thoracolumbar burst fractures. J Spinal Disord Tech 2009;22:417-21.
9. Jonathan-James T, Chen J, Mitsunaga M. Short same-segment fixation of thoracolumbar burst fractures. Spine J 2010;10:109-14.
10. Moon M, Choi W, Sun D, Chae J, Ryu J, Chang H, et al. Instrumented ligamentotaxis and stabilization of compression and burst fractures of dorsolumbar and mid-lumbar spines. Indian J Orthop 2007;41:346-53.
11. Huang W. Efficacy analysis of pedicle screw internal fixation of fractured vertebrae in the treatment of thoracolumbar fractures. ExpTher Med 2013;5:678-82.
12. Wang L, Li J, Wang H, Yang Q, Lv D, Zhang W, et al. Posterior short segment pedicle screw fixation and TLIF for the treatment of unstable thoracolumbar/lumbar fracture. J MusculoskeletDisord 2014;15:1-11.
13. Patil RP, Joshi V. Comparative study between short segment open versus percutaneous pedicle screw fixation with indirect decompression in management of acute burst fracture of thoracolumbar and lumbar spine with minimal neurological deficit in adults. J Spine 2016;5:1-5.
14. Bensch FV, Koivikko MP, Kiuru MJ, Koskinen SK. The incidence and distribution of burst fractures. EmergRadiol 2006;12:124-9.
15. Harrington PR. The history and development of Harrington instrumentation. ClinOrthopRelat Res 1973;93:110-2.
16. Zhao Q, Gu X, Yang H, Liu Z. Surgical outcome of posterior fixation, including fractured vertebra, for thoracolumbar fractures. Neurosciences 2015;20:362-7.
17. Wang J. Treatment of thoracolumbar vertebrate fracture by transpedicular morselized bone grafting in vertebrae for spinal fusion and pedicle screw fixation. J Huazhong Univ Sci Technol Med Sci 2008;28:322-6.
18. Kim BG, Dan JM, Shin DE. Treatment of thoracolumbar fracture. Asian Spine J 2015;9:133-46.
19. Gurwitz GS, Dawson JM, McNamara MJ, Federspiel CF, Spengler DM. Biomechanical analysis of three surgical approaches for lumbar burst fractures using short-segment instrumentation. Spine (Phila Pa 1976) 1993;18:977-82.
20. Farookhi MR. Inclusion of the fracture level in short segment fixation of thoracolumbar fractures. Eur Spine J 2010;19:1651-6.
21. Machino M, Yukawa Y, Nakashima H, Kato F. Posterior/anterior combined surgery for thoracolumbar burst fractures–posterior instrumentation with pedicle screws and laminar hooks, anterior decompression and strut grafting. Spinal Cord 2011;49:573-9.
22. Canbek U, Karapinar L. Posterior fixation of thoracolumbar burst fractures: Is it possible to protect one segment in the lumbar region?. Eur J OrthopSurgTraumatol 2014;24:459-65.
23. Wilcox RK, Boerger TO, Allen DJ, Barton DC, Limb D, Dickson RA, et al. A dynamic study of thoracolumbar burst fractures. J Bone Joint Surg 2003;85:2184-9.
24. Sjöström L, Jacobsson O, Karlström G, Pech P, Rauschning W. Spinal canal remodelling after stabilization of thoracolumbar burst fractures. Eur Spine J 1994;3:312-7.
25. Wessberg P, Wang Y, Irstam L, Nordwall A. The effect of surgery and remodelling on spinal canal measurements after thoracolumbar burst fractures. Eur Spine J 2001;10:55-63.
26. Fairbank JC, Pynsent PB. The Oswestry disability index. Spine (Phila Pa 1976) 2000;25:2940-53.
27. Zou J, Zhang L, Shi J, Gan M. Treatment of thoracolumbar burst fractures: Short-segment pedicle instrumentationversus kyphoplasty. ActaOrthopBelg 2013;79:718-25.
28. Glassman S, Gornet MF, Branch C, Polly D, Peloza J, Schwender JD, et al. MOS short form 36 and Oswestry disability index outcomes in lumbar fusion: A multicenter experience. Spine J 2006;6:21-6.
29. Singh R, Rohilla RK, Kamboj K, Magu NK, Kaur K. Outcome of pedicle screw fixation and monosegmental fusion in patients with fresh thoracolumbar fractures. Asian Spine J 2014;8:298-308.
30. Canto FR. Low thoracic and lumbar burst fractures: Radiographic and functional outcomes. Eur Spine J 2007;16:1934-43.
31. Chadha M, Bahadur R. Steffee variable screw placement system in the management of unstable thoracolumbar fractures: A third world experience. Injury 1998;29:737-47.

How to Cite this article: Shetty MB, Venugopal V, Gnany J | Study of Functional and Radiological Outcome of Short-Segment Pedicle Screw Fixation for Thoracolumbar Fractures with use of Pedicle Screws in Fractured Vertebrae | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 7-15.

                                          (Abstract    Full Text HTML)      (Download PDF)

A Comprehensive Assessment of the Coracoid Process Dimensions in the South Indian Population Using 3D Computer Tomographic Reconstruction

/0 Comments/in /by

Volume 8 | Issue 2 | Aug – Sep 2020 | Page: 37- 46 | Sandesh Madi S, Muthiah Muthu Magesh, Sujayendra DM, Vivek Pandey, Kiran K V Acharya

Authors: Sandesh Madi S [1], Muthiah Muthu Magesh [1], Sujayendra DM [1], Vivek Pandey [1], Kiran K V Acharya [1]

[1] Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.

Address of Correspondence
Dr. Sandesh Madi S,
Kasturba Medical College, Manipal Academy of Higher
Education, Manipal, India.
E-mail: sandesh.madi@manipal.edu

Abstract

Background: Awareness of the accurate dimensions of the coracoid is essential for (i) coracoclavicular ligament reconstructions and (ii) coracoid transfer procedures (e.g. Latarjet) for shoulder instability. The morphometric assessment of the coracoid process using three-dimensional computer tomography (3-D CT) in the Indian population has not been previously undertaken.
Materials and Methods: The study was aimed to conduct the morphometric assessment of coracoid process using 3-D CT reconstruction in the South Indian population and to compare the gender and side differences. In addition, we compared the dimensions of the coracoid process with the findings in the previous studies performed in different races and ethnicities. We also compared the results of our study with other morphometric studies conducted in India using dry bones. From the records, the 3D CT images of the shoulder (age between 20 and 60 years) were assessed. Fractures of the coracoid or previous history of surgery involving the coracoid were excluded from the study. The dimensions of coracoid were measured on the same final images by two observers using digital calipers, and an average of their measurements was recorded. A two-tailed independent t-test was used to measure the statistical significance.
Results: A total of 187 shoulders (120 males and 67 females), 3D CT images were assessed. The average age of the study population was 30.66 ± 7.21 years. The average length of coracoid was 40.11 ± 1.36 mm. Overall dimensions of tip of coracoid was 20.56 ± 1.67 mm (length), 13.01 ± 0.97 mm (width), and 9.24 ± 1.05mm (height). Overall dimensions of base of coracoid were 20.45 ± 2.26 mm (length) and 14.5 ± 0.86 mm (height). All the measurements were larger in males (P < 0.05). The side difference for all measurements was not statistically significant. The mean coracoid width was significantly larger than the mean coracoid thickness (P < 0.00001).
Conclusion: This study provides a comprehensive baseline data on the morphometry of the coracoid process in the South Indian population that will be valuable in pre-operative planning for the shoulder surgeons.
Keywords: Coracoid, Three-dimensional computer tomography scan, Tip, Base, Scapula, Shoulder.

References

1. Latarjet M. Technic of coracoid preglenoid arthroereisis in the treatment of recurrent dislocation of the shoulder. Lyon Chir 1958;54:604-7.
2. Gumina S, Postacchini F, Orsina L, Cinotti G. The morphometry of the coracoid process-its aetiologic role in subcoracoid impingement syndrome. Int Orthop 1999;23:198-201.
3. Coskun N, Karaali K, Cevikol C, Demirel BM, Sindel M. Anatomical basics and variations of the scapula in Turkish adults. Saudi Med J 2006;27:1320-5.
4. Salzmann GM, Paul J, Sandmann GH, Imhoff AB, Schöttle PB. The coracoidal insertion of the coracoclavicular ligaments: An anatomic study. Am J Sports Med 2008;36:2392-7.
5. Rios CG, Arciero RA, Mazzocca AD. Anatomy of the clavicle and coracoid process for reconstruction of the coracoclavicular ligaments. Am J Sports Med 2007;35:811-7.
6. Armitage MS, Elkinson I, Giles JW, Athwal GS. An anatomic, computed tomographic assessment of the coracoid process with special reference to the congruent-arc latarjet procedure. Arthroscopy 2011;27:1485-9.
7. Dolan CM, Hariri S, Hart ND, McAdams TR. An anatomic study of the coracoid process as it relates to bone transfer procedures. J Shoulder Elbow Surg 2011;20:497-501.
8. Coale RM, Hollister SJ, Dines JS, Allen AA, Bedi A. Anatomic considerations of transclavicular-transcoracoid drilling for coracoclavicular ligament reconstruction. J Shoulder Elbow Surg 2013;22:137-44.
9. Terra BB, Ejnisman B, De Figueiredo EA, Cohen C, Monteiro GC, De Castro Pochini A, et al. Anatomic study of the coracoid process: Safety margin and practical implications. Arthroscopy 2013;29:25-30.
10. Imma II, Nizlan MN, Ezamin AR, Yusoff S, Shukur MH. Coracoid process morphology using 3D-CT imaging in a Malaysian population. Malays Orthop J 2017;11:30-5.
11. Bueno RS, Ikemoto RY, Nascimento LG, Almeida LH, Strose E, Murachovsky J. Correlation of coracoid thickness and glenoid width: An anatomic morphometric analysis. Am J Sports Med 2012;40:1664-7.
12. Cho BP. Articular facets of the coracoclavicular joint in Koreans. Acta Anat (Basel) 1998;163:56-62.
13. Gallino M, Santamaria E, Doro T. Anthropometry of the scapula: Clinical and surgical considerations. J Shoulder Elbow Surg 1998;7:284-91.
14. Boutsiadis A, Bampis I, Swan J, Barth J. Best implant choice for coracoid graft fixation during the latarjet procedure depends on patients’ morphometric considerations. J Exp Orthop 2020;7:15.
15. Piyawinijwong S, Sirisathira N, Chuncharunee A. The scapula: Osseous dimensions and gender dimorphism in Thais. Siriraj Hosp Gaz 2004;56:356-65.
16. Von Schroeder HP, Kuiper SD, Botte MJ. Osseous anatomy of the scapula. Clin Orthop Relat Res 2001;383:131-9.
17. Cirpan S, Yonguc GN, Güvençer M. Morphometric analysis of coracoid process and glenoid cavity in terms of surgical approaches: An anatomical study. Kocaeli Med J 2018;7:131-7.
18. Lian J, Dong L, Zhao Y, Sun J, Zhang W, Gao C. Anatomical study of the coracoid process in Mongolian male cadavers using the latarjet procedure. J Orthop Surg Res 2016;11:126.
19. Shibata T, Izaki T, Miyake S, Doi N, Arashiro Y, Shibata Y, et al. Predictors of safety margin for coracoid transfer: A cadaveric morphometric analysis. J Orthop Surg Res 2019;14:10-5.
20. Knapik DM, Cumsky J, Tanenbaum JE, Voos JE, Gillespie RJ. Differences in coracoid and glenoid dimensions based on sex, race, and age: Implications for use of the latarjet technique in glenoid reconstruction. HSS J 2018;14:238-44.
21. Fathi M, Cheah PS, Ahmad U, Nasir MN, San AA, Rahim EA, et al. Anatomic variation in morphometry of human coracoid process among Asian population. Biomed Res Int 2017;2017:6307019.
22. Jia Y, He N, Liu J, Zhang G, Zhou J, Wu D, et al. Morphometric analysis of the coracoid process and glenoid width: A 3D-CT study. J Orthop Surg Res 2020;15:1-7.
23. Khan R, Satyapal KS, Lazarus L, Naidoo N. An anthropometric evaluation of the scapula, with emphasis on the coracoid process and glenoid fossa in a South African population. Heliyon 2020;6:e03107.
24. Lo IK, Burkhart SS, Parten PM. Surgery about the coracoid: Neurovascular structures at risk. Arthroscopy 2004;20:591-5.
25. Chavan SR, Bhoir MM, Verma S. A study of anthropometric measurements of the human scapula in Maharashtra, India. Int J Anat 2017;1:23-6.
26. Rajan S, Ritika S, K.J S, Kumar S, Tripta S. Role of coracoid morphometry in subcoracoid impingement syndrome. Internet J Orthop Surg 2014;22:1-7.
27. Mehta V. Osteometric assessment of coracoid process of scapula-clinical implications. J Surg Acad 2018;8:3-10.
28. Jagiasi J, Yeotiwad G, Bhoir M, Sahu D. Anatomic measurements of the coracoid and its implication in the latarjet procedure. Int J Orthop Sci 2017;3:533-5.
29. Nayak G, Panda SK, Chinara PK. Acromion, coracoid and glenoid processes of scapula: An anatomical study. Int J Res Med Sci 2020;8:570.
30. Lingamdenne PE, Marapaka P. Measurement and analysis of anthropometric measurements of the human scapula in Telangana region, India. Int J Anat Res 2016;4:2677-83.
31. Kalra S, Thamke S, Khandelwal A, Khorwal G. Morphometric analysis and surgical anatomy of coracoid process and glenoid cavity. J Anat Soc India 2016;65:114-7.
32. Parmar T, Geethanjali BS. A study of anthropometric measurement of human dry scapula and its clinical importance. Sch Int J Anat Physiol 2019;8618:187-93.
33. Verma U, Singroha R, Malik P, Rathee SK. A study on morphometry of coracoid process of scapula in North Indian population. Int J Res Med Sci 2017;5:4970.
34. Gregori M, Eichelberger L, Gahleitner C, Hajdu S, Pretterklieber M. Relationship between the thickness of the coracoid process and latarjet graft positioning-an anatomical study on 70 embalmed scapulae. J Clin Med 2020;9:207.
35. Eyres KS, Brooks A, Stanley D. Fractures of the coracoid process. J Bone Joint Surg Br 1995;77:425-8.
36. Ljungquist KL, Butler RB, Griesser MJ, Bishop JY. Prediction of coracoid thickness using a glenoid width-based model: Implications for bone reconstruction procedures in chronic anterior shoulder instability. J Shoulder Elbow Surg 2012;21:815-21.
37. Bonazza NA, Liu G, Leslie DL, Dhawan A. Trends in surgical management of shoulder instability. Orthop J Sports Med 2017;5:1-7.
38. Zhang AL, Montgomery SR, Ngo SS, Hame SL, Wang JC, Gamradt SC. Arthroscopic versus open shoulder stabilization: Current practice patterns in the United States. Arthroscopy 2014;30:436-43.
39. Beer JF, Roberts C. Glenoid bone defects-open latarjet with congruent arc modification. Orthop Clin North Am 2010;41:407-15.

How to Cite this article: Madi SS, Magesh MM, Sujayendra DM, Pandey V, Acharya KKV | A Comprehensive Assessment of the Coracoid Process Dimensions in the South Indian Population Using 3D Computer Tomographic Reconstruction | Journal of Karnataka Orthopaedic Association | August-September 2020; 8(2): 37-45.

                                          (Abstract    Full Text HTML)      (Download PDF)