Orthopaedic Diseases and Traumatology

Editorial Ritesh Runu Journal of Orthopaedic Diseases and Traumatology 2020 3(3):103-103

Brodie's abscess: Brief review of key updates from the year 2010 Ganesh Singh Dharmshaktu Journal of Orthopaedic Diseases and Traumatology 2020 3(3):104-108 Brodie's abscess is an uncommon condition presenting as a subacute type of bone infection leading to localized pus collection. The common clinical presentation ranges from mild pain to serious functional impairment. The judicious radiological investigation helps in early diagnosis in suspected cases. The presence of a well-defined lytic lesion surrounded by sclerotic margins is a typical radiological feature that after exclusion may lead to a provisional diagnosis. The use of magnetic resonance imaging may prove supportive in further characterization of lesions and exclusion of related disorders. Final confirmation requires culture or histopathological evaluation following aspiration or biopsy following surgical drainage. The overall outcome has been good, following the appropriate diagnosis and management. This article attempts to give readers an overview of the reported cases or small series in the last decade (2010 onwards) in PubMed. This shall serve as a recollection of the spectrum of the clinical presentation and management of Brodie's abscess for educative purposes.

Arthroscopic correlation of ligamentous injury in adult knee with magnetic resonance imaging Rahul Kumar Gupta, Shubhda Sagar, Arunim Swarup, Abhay Shankar Dube, Avinash Kumar, Avinash Rastogi Journal of Orthopaedic Diseases and Traumatology 2020 3(3):109-111 Background: The purpose of this study was to compare the magnetic resonance imaging (MRI) and arthroscopic findings of internal derangement of adult knee joint. Aims and Objective: The objective was also to find out the value of MRI in the finding of ligamento-meniscal injury in adult knee joint during arthroscopy. Material and method: Ligamento-meniscal injury in 45 patients was subjected to MRI evaluation using hospital Sigma contour MRI with a field strength of 1.5 Tesla using 4-mm slice thickness, and those who had significant ligamento-meniscal findings underwent diagnostic and/or therapeutic arthroscopic procedure. Result: The sensitivity and specificity of MRI and arthroscopic findings of these injuries were found for medial meniscus to be 95.83% and 76.19%; for lateral meniscus 86.67% and 90%; for anterior cruciate ligament 97.37% and 85.71%; and posterior cruciate ligament 100% and 97.67%, respectively. Conclusion: The authors maintained that while arthroscopy, though invasive, is the gold standard to diagnose ligamento-meniscal injury, MRI is a noninvasive modality with high sensitivity and specificity for diagnosis and can be done to avoid arthroscopy, which should be best used for the therapy of significant ligamento-meniscal injuries.

The clinical characteristics and conservative management of isolated iliac wing fractures: A single-center experience from North India Ganesh Singh Dharmshaktu, Navneet Adhikari, Pankaj Mourya, Shailendra Singh Bhandari Journal of Orthopaedic Diseases and Traumatology 2020 3(3):112-115 Background: The fracture of iliac bone or blade is uncommon injury and usually a part of pelvic ring disruption with varied clinical presentation. Isolated iliac bone fractures are rare, with literature limited to few reports or small series. Materials and Methods: Retrospective data of consecutive cases of isolated iliac bone fractures were analyzed during the period of July 2014 to August 2019. Relevant patient demographics, mode of injury, pattern of fracture, associated adjacent regional or remote injuries were noted for each case. Details of previous treatment and that of treatment given by us were also noted for each case. Results: A total of 18 cases with isolated iliac bone fracture of the pelvic bone were noted. The mean age was 31.2 years (range: 22–54 years). All the cases were male, and fall from height was etiology in 12 cases, followed by road traffic accidents in the rest. Left- and right-side involvement was noted in 11 and 7 cases each. The fracture pattern was minimally displaced simple in 13 and comminuted in 5 cases. The conservative management was done in all cases. The radiological union and clinical stability of fractures were assessed as end points. The fracture united in all cases within 8–9 weeks and without any immediate or remote complication. Level of evidence - Level 5, Observational Study. Conclusion: The uncommon isolated iliac wing fractures require better recognition and documentation for its management. Further studies should provide a better understanding of these injuries and treatment guidelines.

Functional assessment of diaphyseal femoral fractures in pediatric age group managed by titanium elastic nail system: A prospective study Karan Siwach, Virender Kumar, Kunal Arora, Rajpal Beniwal, Ankit Mittal, Gaurav Nandal Journal of Orthopaedic Diseases and Traumatology 2020 3(3):116-120 Background: Femoral shaft fractures are common childhood injuries and are among common causes for hospitalization in children. Treatment varies with child's age. There is little room for question in treatment guidelines in children below the age of 3 years, but in the age group of 4–14 years, it is still a matter of debate. There is a trend toward surgical intervention with the advent of newer surgical techniques. This study aims to evaluate the functional outcome of titanium elastic nail system (TENS) for the treatment of femoral diaphyseal fractures in this age group. Materials and Methods: This study included 63 children between 4 and 14 years of age who sustained femoral diaphyseal fractures and were managed by TENS nailing during the period of the study between April 2017 and April 2020. Results: All patients showed union; there were no cases of nonunion or delayed union or implant failure. Three patients had exposed implant, and 15 developed superficial infections which subsided with antibiotic treatment. Forty-eight patients had excellent Flynn score, and 15 had a satisfactory score. Conclusion: In our series of patients, we concluded that TENS nailing in the study group was easy and reliable. As it is a load-sharing device and does not violate the physis, it allows early mobilization and maintenance of alignment. Other notable advantages include decreased risk of infection and undisturbed fracture hematoma. Superficial infection was one of the commonly observed complications which subsided with oral antibiotics.

Reduction and functional outcome of open reduction and internal fixation with plate versus minimally invasive screw fixation in displaced intra-articular calcaneum fractures Farhan Sozera, Sajid Younus, Naveed Memon, Nouman Memon, Kazim Raheem Najjad, Abdul Rafay Qazi Journal of Orthopaedic Diseases and Traumatology 2020 3(3):121-126 Introduction: Calcaneum fracture accounts for 2% of all fractures and 60% of all tarsal bone fractures. The most favored treatment for intra-articular fractures is open reduction and internal fixation using an extended lateral approach. The use of minimally invasive reduction and fixation of calcaneal fractures may have a role in this group of patients where there is a concern regarding wound healing and infection. Materials and Methods: This was a prospective study conducted from April 1, 2016, to April 30, 2018. Eighteen patients were included in the study. Preoperative and postoperative plain radiographs were compared for reduction parameters (improvement of Bohler's angle or Gissane's angle, the width of the calcaneus), Functional outcome was assessed using American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot score and visual analog scale. Results: The patients followed up for an average of 15.56 ± 4.85 months. No significant differences in reduction were observed between the open and closed groups (P > 0.05). The average AOFAS scores of the two groups were 76.45 ± 6.83 and 84.65 ± 7.65 (open versus closed) (P = 0.087). The mean visual analog scores of the open and closed groups were 1.38 ± 1.15 and 0.75 ± 0.45 (P = 0.034). The complication rates of the open and closed groups were 33% (3/9) and 10% (1/9) (P = 0.0053). Conclusion: Closed reduction and percutaneous screw fixation have shown better results in terms of outcome and complications. However, multicenter controlled randomized clinical trials are still required prior to widespread practical implementation.

A short-term comparative analysis of the efficacy of platelet-rich plasma therapy and corticosteroid injection in lateral epicondylitis Anant Akash, Sanjay Gupta, Apser Khan, Milan Jaiswal Journal of Orthopaedic Diseases and Traumatology 2020 3(3):127-132 Background: Tennis Elbow, a common overuse syndrome, is a tendonitis of the extensor muscles of the forearm mainly due to intratendinous degeneration associated with aging, repetitive movement, and vascular compromise. Autologous platelet-rich plasma (PRP) injections represent a new therapeutic option for chronic tendinopathies including tennis elbow. The purpose of the present study was to assess the therapeutic effect, efficacy, and safety of a single injection of PRP and corticosteroid in improving pain and function in patients suffering from lateral epicondylitis over a short term. Materials and Methods: Sixty patients with lateral epicondylitis were randomized into two groups to receive one injection of PRP or corticosteroid and were followed for 3 months. The two groups were compared as regards pain and functional improvement using the visual analogue scale (VAS) and the patient-rated tennis elbow evaluation (PRTEE) Score, by assessing the patients three times postintervention. Results: VAS scale showed that both modalities were effective in pain reduction. PRTEE score represented variably improved symptoms, i.e., decrease in pain and better function along with improvement in daily activity after 3 months in both groups. Conclusion: As the degree of pain relief achieved by the respective modalities was almost similar, the most important difference between the intervention groups was the duration of their effectiveness. PRP is suggested to be superior in the duration of pain relief when compared to corticosteroids. We can propose that PRP can be administered less often and more conveniently as compared to corticosteroid for lateral epicondylitis.

Segmental tibial fracture with physeal and diaphyseal fracture causing popliteal artery and common peroneal nerve injury in a 12-year-old child: A rare case with a unique injury mechanism Tungish Bansal, Sandeep Patel, Pebam Sudesh, Vishal Kumar Journal of Orthopaedic Diseases and Traumatology 2020 3(3):133-135 Proximal tibial physeal injuries with neurovascular injuries are rare. Here, we report the case of a 12-year-old boy with a rare fracture pattern that is segmental tibia fracture with physeal and diaphyseal fracture with popliteal artery and common peroneal nerve injury, which has never been reported earlier to the best of our knowledge. We also discuss the possible mechanism of injury and also describe the surgical decision-making and highlight the importance of prompt identification and early management of such patients for a good clinical outcome.

Dr. Bijay Narain Singh Rajeev Anand Journal of Orthopaedic Diseases and Traumatology 2020 3(3):136-136

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