A Comparative Study on Functional Outcomes of Fixed Versus Adjustable Length-Loop Device for Femoral Fixation of Graft in Anterior Cruciate Ligament Reconstruction

Vol 43 | January 2022 | page: 44-49 | Dharmaraj Nag

DOI: 10.13107/ojot.2022.v43i01.033


Authors: Dharmaraj Nag [1]

[1] Department of Orthopaedics, SCB Medical College, Cuttack, Odisha, India.

Address of Correspondence

Dr. Dharmaraj Nag,
Department of Orthopaedics, SCB Medical College, Cuttack, Odisha, India.
E-mail: drdharmarajnag@gmail.com


Abstract


Background: ACL injury is one of the most common injuries of knee among high level athletes and also common in young and non-sports people. Intra-articular anatomical ACL reconstruction (ACLR) with a biologic graft has become the gold standard for the treatment of ACL tear. The use of the semitendinosus and gracilis (STG) tendons is becoming the choice method in anterior cruciate ligament (ACL) reconstruction. Cortical suspensory fixation is the current preferred Femoral fixation method & is in wide-spread use. Cortical suspension device available in two varieties – 1. Fixed Loop-Length device (FLD) e.g. Endobutton; 2. Adjustable Loop-Length device (ALD) e.g. Tightrope, Toggleloc, ZipLoop. We conducted this prospective study to find out which device fared better in terms of functional outcomes and laxity measurements at a final follow up of 1 year.
Study design: prospective study
Material and methods: This is prospective study conducted in the PG Department of Orthopaedics in S.C.B medical college & hospital from June 2018 to February 2020. There were 53 patients included in our study. All patients presenting with history of trauma to the knee in the Orthopaedics emergency and outpatient departments in SCB Medical College were evaluated by a thorough general and local examination of the knee. Routine radiographs in antero-posterior view and lateral view of the affected knee were taken. MRI of the knee was done in all suspected ACL torn cases for confirmation. Patients who have chosen to undergo ACL repair surgery are then randomly selected and allocated to two groups, group 1 are the patients operated with fixed loop suspension devices and group 2 patients are operated with adjustable loop suspension devices. All patients underwent ACLR with 4 strand, autologous hamstring grafts and fixed in the tibial side with a bio-degradable interference screw.
Study center: SCB medical college &hospital, Cuttack between June 2018- February 2020.
Results: Tegner Lysholm Score shows no difference between both the groups at any point of time. At last follow up of 12 months the Tegner Lysholm score was 93.05±4.04 in Fixed loop group and 92.81±2.96 in Adjustable Loop group. The difference is not significant at 3 months, 6 months and 12 months with p values 0.726, 0.572 and 0.805 respectively. KOOS Score for pain shows no difference between both the groups at any point of time. At last follow up of 12 months the KOOS score for pain was 91.86±3.73 in Fixed loop group and 91.79±3.46 in Adjustable Loop group. The difference is not significant at 3 months, 6 months and 12 months with p values 0.545, 0.490 and 0.949 respectively. KOOS Score for symptoms shows no difference between both the groups at any point of time. At last follow up of 12 months the KOOS score for symptoms was 95.90±3.73 in Fixed loop group and 96.16±3.46 in Adjustable Loop group. The difference is not significant at 3 months, 6 months and 12 months with p values 0.968, 0.626 and 0.797 respectively. KOOS Score for Activities for Daily Living shows no difference between both the groups at any point of time. At last follow up of 12 months the KOOS score for activities for daily living was 91.59±2.49 in Fixed loop group and 91.22±1.99 in Adjustable Loop group. The difference is not significant at 3 months, 6 months and 12 months with p values 0.757, 0.566 and 0.549 respectively. KOOS Score for sports and recreations shows no difference between both the groups at any point of time. At last follow up of 12 months the KOOS score for pain was 85.00±6.54 in Fixed loop group and 85.65±7.15 in Adjustable Loop group. The difference is not significant at 3 months, 6 months and 12 months with p values 0.545, 0.781 and 0.739 respectively. KOOS Score for quality of life shows no difference between both the groups at any point of time. At last follow up of 12 months the KOOS score for pain was 86.64±9. 10 in Fixed loop group and 88.30±7.17 in Adjustable Loop group. The difference is not significant at 3 months, 6 months and 12 months with p values 0.876, 0.790 and 0.462 respectively.
Conclusions: Arthroscopic ACL reconstruction using fixed loop or adjustable loop suspensory devices are equally effective fixation alternatives. It gives equal functional outcome in both cases, in terms of Tegner-Lysholm score & Knee-injury & Osteoarthritis Outcomes Score. Proper technique with appropriate tunnel positioning are the main factors of ACL reconstruction. Although many in vitro studies have shown that adjustable loop devices are biomechanically inferior to fixed loop devices, previous clinical studies as well as our study fail to corroborate this. The logical step forward would be to conduct well designed Randomized Control Trials comparing the two devices. Until further evidence clearly shows the superiority of one device over the other, it can be expected to yield similar results.
Keywords: ACL reconstruction, Adjustable length loop device, Fixed loop device


References


1. Pokhrel B, Bhalodia M, Raut A and Gajjar SM. Comparative study on fixed versus adjustable length loop device for femoral fixation of graft in ACL reconstruction.IJOS 2018;4(1):889-892.
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4. Darby A. Houck, Matthew J. Kraeutler, Eric C. McCarty, and Jonathan T. Bravman,Fixed- Versus Adjustable-Loop Femoral Cortical Suspension Devices for Anterior Cruciate Ligament Reconstruction. The Orthopaedic Journal of Sports Medicine.2018;6(4):1-10
5. McCarty E. Et al.Fixed – Vs Adjustable- loop femoral cortical suspension devices for Anterior cruciate ligament reconstruction.
6. Rahul Ranjan , SahilGaba , LakshayGoel , Naiyer Asif, MukeshKalra , Ramesh Kumar and Arvind Kumar.In vivo comparison of a fixed loop (EndoButton CL) with an adjustable loop (TightRope RT) device for femoral fixation of the graft in ACL reconstruction: A prospective randomized study and a literature review. Journal of Orthopaedic Surgery .2018;26(3) 1–7
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How to Cite this Article: Nag D | A Comparative Study on Functional Outcomes of Fixed Versus Adjustable Length-Loop Device for Femoral Fixation of Graft in Anterior Cruciate Ligament Reconstruction | Odisha Journal of Orthopaedics & Trauma | January 2022; 43: 44-49.



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Short Term Analysis of the Functional and Radiological Outcome of Distal Femoral Fractures Fixed with Locking Compression Plate by Minimally Invasive Plate Osteosynthesis (MIPO) Technique

Vol 43 | January 2022 | page: 39-43 | Sidheswar Baskey

DOI: 10.13107/ojot.2022.v43i01.032


Authors: Sidheswar Baskey [1]

[1] Department of Orthopaedic Surgery, SCB Medical College and Hospital, Cuttack, Odisha, India.

Address of Correspondence

Dr. Sidheswar Baskey
Department of Orthopaedic Surgery, SCB Medical College and Hospital, Cuttack, Odisha, India.
E-mail: stylishdoc@gmail.com


Abstract


Background: Fractures of distal femur are very complex injuries and there is significant difficulty to manage. These injuries are severe and have a potential to produce long term disability. These fractures often are unstable and comminuted and tend to occur in elderly or multiply-injured patients.

The fractures of distal femur account for 7% of all femoral fractures. If Hip fractures are excluded, 31% of fractures involve the distal femur. The fractures involving distal 15 cm of femur including distal femoral metaphysis (supracondylar) and articular surface (intercondylar) are classified as distal femur fractures [1].

Distal femur fractures exhibits bimodal age distribution. In young adults it occurs due to high velocity trauma like road traffic accidents. These patients often sustain multiple and compound injuries. Older patients sustain distal femur fractures mostly due to trivial fall occurring in elderly osteoporotic bone.

In 1960’s most of these fractures were treated conservatively and documented better outcome than operative treatment. But with the advent of newer implants and modern techniques, these fractures are best treated with surgical stabilization. The newer modalities of treatment include minimally invasive plate osteosynthesis (MIPO) and Less invasive skeletal stabilization (LISS).
Aim of this study: To evaluate twenty cases of distal femur fractures fixed with locking compression plate by minimally invasive plate osteosynthesis (MIPO) technique in the Department of Orthopaedic Surgery at SCB Medical College and Hospital, Odisha between July 2018 to November 2020. To prospectively analyse the clinical and radiological outcome of the above procedure.
Keywords: Minimally Invasive Plate Osteosynthesis (MIPO), Distal Femoral Fractures, Radiological Outcome, Locking Compression Plate


References


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How to Cite this Article: Baskey S | Short Term Analysis of the Functional and Radiological Outcome of Distal Femoral Fractures Fixed with Locking Compression Plate by Minimally Invasive Plate Osteosynthesis (MIPO) Technique | Odisha Journal of Orthopaedics & Trauma | January 2022; 43: 39-43.



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Long Term Results of Valgus Intertrochanteric Osteotomy in Old Fracture Neck of Femur – A Prospective Analysis

Vol 43 | January 2022 | page: 34-38 | Suvam Choudhury, T S K Gupta, Subhransu S. Nayak, Tanmoy Mohanty

DOI: 10.13107/ojot.2022.v43i01.031


Authors: Suvam Choudhury [1], T S K Gupta [2], Subhransu S. Nayak [1], Tanmoy Mohanty [1]

[1] Department of Orthopaedics, S C B Medical College & Hospital, Cuttack, Odisha, India.
[2] Department of Orthopaedics, Fakir Mohan Medical College, Balasore, Odisha, India.

Address of Correspondence

Dr. Tanmoy Mohanty,
Department of Orthopaedics, S C B Medical College & Hospital, Cuttack, Odisha, India.
E-mail: tanmoy_mohanty@yahoo.com


Abstract


A prospective study (data collected retrospectively from January 2011 to December 2018) was conducted in the department of orthopaedics in SCB Medical College and Hospital from December 2018 to December 2020 on patients with old fracture neck of femur. A total of 42 cases were included for the study who had undergone this surgery before December 2019. Valgus Intertrochanteric Osteotomies included McMurray’s Osteotomy, Modified Pauwel’s Osteotomy and Transfracture Abduction Osteotomy. Thirty six patients were followed up only as Six patients could not be contacted. Valgus Intertrochanteric Osteotomy of proximal femur was found to be the mainstay of the treatment in young patients. Initially Mc Murrays Osteotomy was preferred but in recent times modified Pauwel’s Intertrochanteric Valgus Osteotomy and Trans Fracture Abduction Osteotomy was considered as an augmentation to the healing of a fracture neck of femur which presented late.
Keywords: Valgus intertrochanteric osteotomy, Old neck of femur fracture, Fixation


References


1. Shea FW: A method of controlled bone division in the McMurray osteotomy: From the General Infirmary, Leeds Vol 41 B, No 4, November 1959.
2. Fidler M: Planning an intertrochanteric femoral osteotomy: Acta Orthop Scand 55, 501-503, 1984.
3. Ballmer FT, Ballmer PM, Baumgartel F: Pauwel’s osteotomy for non-union of the femoral neck. Orthop Clin North Am. 1990; 21: 759-67.
4. Phaltankar PM, Bhavnani K, Kale S, Sejale S, Patel BR. Is McMurray’s osteotomy obsolete? Journal of Postgraduate Medicine, 01 Oct 1995, 41(4):102-103.
5. Mathew V, Berry DJ Trousdale RT, Cabenale ME, Poster: Clinical and Functional result of valgus intertrochanteric osteotomy for femur neck non union annual meeting proceeding Rosenmont, il. American academy of orthopaedic surgery 2003:380.
6. Bartonicek J, Skala-Rosenbaum J, Dousa P: Valgus intertrochanteric osteotomy for malunion and non-union of trochanteric fractures. J Orthop Trauma. 2003; 17:606-12.
7. Upadhay A, Jain P, Mishra P, Maini L, Gautam VK, Dhoan BK: Delayed internal fiXation of fractures of femur neck in young. J Bone Joint Surg Br 2004; 86: 1035-40.
8. Hardas Singh Sandhu et al: Management of fracture neck of femur-IOA white paper: Indian J of Orthop. 2005, Volume : 39,Issue : 2, Page : 130- 136.
9. Magu NK, Rohilla R , Singh R , Tater R : Modified Pauwels’ Intertrochanteric Osteotomy in Neglected Femoral Neck Fracture.ClinOrthopRelat Res. 2009 Apr; 467(4): 1064–1073.
10. Said GZ, Farouk O, Said HGZ: Valgus Intertrochanteric Osteotomy with single- angled 130 degrees plate fiXation for fractures and non-unions of the femoral neck: International Orthopaedics (SICOT) (2010) 34:1291-1295.
11. Pingle J: Transfracture Abduction Osteotomy: A Solution for non-union of femoral neck fractures; Ind Jour Ortho, 2014, Vol: 48(1), P: 25-29.
12. Puttaswamy MK, Kudapalli M: Neglected neck of femur fracture: Valgus Intertrochanteric Osteotomy, rigid internal fiXation and cortical bone g r a f t i n g : Fo r go t t e n b u t u s e f u l t e c h n i q u e : Jo u r n a l o f Orthopaedics,Traumatology and rehabilitation Vol 7 Issue 2 May-Aug 2014.
13. Jain AK, Mukunth R, Srivastava A: Treatment of neglected femoral neck fracture, Indian J Orthop. 2015 Jan-Feb; 49(1) : 17-27.
14. Schwartsmann CR, Spinelli LF, Yepez AK, Boschin LC, Silva MF: Femoral Neck Non-Union Treatment By Valgus Intertrochanteric Osteotomy: Acta Ortop Bras 2015;23(6):319-22.
15. Varghese VD, Livingston A, Boopalan PR, Jepegnanam TS: Valgus Osteotomy for non-union and neglected neck of femur fractures, World Journal of Orthopaedics. May 2016.
16. Mayo K, Kuldjanov D: Generic Preoperative Planning for ProXimal Femoral Osteotomy in the Treatment of Nonunion of the Femoral Neck: J Orthop Trauma 2018;32:S46-S54.
17. Kar BK, Agrawal AC, Yadav SK, Sakale H, Sahoo B. Delayed diagnosed femoral neck fractures. J Orthop Dis Traumatol 2018;1:15-20.
18. Banaszek D, Spence D, O’Brien P, Lefaivre K: Principles of Valgus Intertrochanteric Osteotomy (VITO) after Femoral Neck Nonunion: Vancouver General Hospital, Division of Orthopaedic Trauma, December 2018.
19. Medda S, Jinnah AH, Marquez-Lara A, Araiza ET, Hasty EK, Halvorson JJ, Pilson HT: Valgus Intertrochanteric Osteotomy for Femoral Neck Nonunion: Journal of Orthopaedic Trauma 2019;33:S26-S27.
20. Nayak C, Acharyya B, Jain M, Kamboj K: Valgus osteotomy in delayed presentation of femoral neck fractures using fiXed angle simple dynamic hip screw and plate: Chinese Journal of Traumatology 22 (2019) 29-33.


How to Cite this Article: Choudhury S, Gupta TSK, Nayak SS, Mohanty T | Long Term Results of Valgus Intertrochanteric Osteotomy in Old Fracture Neck of Femur – A Prospective Analysis | Odisha Journal of Orthopaedics & Trauma | January 2022; 43: 34-38.


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Evaluation of Single Stage Posterolateral Decompression and Posterior Fixation in Dorsolumbar Spinal Tuberculosis: A Prospective Study

Vol 43 | January 2022 | page: 28-33 | Sachindra Kumar Dash

DOI: 10.13107/ojot.2022.v43i01.030


Authors: Sachindra Kumar Dash [1]

[1] Department of Orthopaedics, S.C.B. Medical College and Hospital, Cuttack, Odisha, India.

Address of Correspondence

Dr. Sachindra Kumar Dash
Department of Orthopaedics, S.C.B. Medical College and Hospital, Cuttack, Odisha, India.
E-mail: lipikadash32@gmail.com


Abstract


Introduction: The study has been designed with all perseverance’s, to observe and evaluate the results of single stage transpedicular decompression and posterior fixation in Dorso Lumbar Spinal Tuberculosis.
Material and Methods: The present study “Evaluation of Single Stage Posterolateral Decompression and Posterior Fixation in Dorsolumbar Spinal Tuberculosis: A Prospective Study” was conducted on clinicopathologically diagnosed cases of spinal tuberculosis of dorsal and lumbar region during a period of two years from “October 2018 to October 2020” in the Department of Orthopaedics, S.C.B. Medical College and Hospital, Cuttack, Odisha.
Method of Collection of Data: This is a clinical and prospective study conducted on patients admitted to S.C.B. Medical College, Cuttack after obtaining ethical clearance from the institutional ethical committee. A total of 25 cases of tuberculosis of spine in thoracic and lumbar region were selected for this procedure after obtaining proper informed and written consent.Patients were admitted based on clinical presentation such as prolonged back pain usually with tender gibbus, with/ without neurologic deficit.
Objective of the Study: The objective of the study is to evaluate the efficacy of single stage posterolateral decompression and posterior fixation in spinal tuberculosis. The patients are to be evaluated postoperatively regarding following parameters: –
• Postoperative neurological status and its improvement
• Degree of pain relief
• Radiological fusion of vertebra
• Correction of angle of kyphosis
Discussion: This piece of work conducted in Department of Orthopaedics, SCB Medical College, Cuttack, is meant for an analytical study of transpedicular decompression and debridement of spinal cord and fixation of the unstable spine by means of screws & rod system in a single stage posterior approach surgery. In our study we followed Tuli’s Middle Path Regimen in the management. Hence, all clinicoradiological diagnosed TB spine cases were administered ATT drugs under govt. sponsored DOTS Therapy Schedule. The pts who didn’t show signs of improvement, or deteriorating neural deficit, or progressive and gross kyphosis, or patients with severe pain were taken up for surgery and then followed up regularly at 3 months interval for a minimum average follow up period of 1 year. In our study, out of 25, 11 patients recovered completely from neurological deficit and was found to have Frenkel grade E. Another 12 patients had recovered to Frenkel grade D. Hence almost 92 percent of patients had satisfactory neurological recovery. In our study fusion was seen in 64 percent of cases which was significant and comparable with the studies of Gueven et al, Lee et al, and Chacko et al. Pain reduced in all cases.
Conclusion: There was neurological recovery in all cases except one, indicating debridement by transpedicular approach is still effective though not radical. Pain was significantly reduced in all cases. Another vital observation was a correction in kyphotic deformity which was significant and also quite stable. There was fusion in more than half of the cases
Keywords: Single Stage Posterolateral Decompression, Posterior Fixation in Dorsolumbar Spinal Tuberculosis, Potts Paraplegia


References


1. Albee F.H. The Bonegraft in TB Spine Journal of American Medical association 94-1930.
2. Bhojraj SY Mehta Tuberculosis of thoracic spine JBJS 2001., 83B.
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14. Sahoo MM, Mahapatra SK, Sethi GC, Dash SK et al. Posterior-only Approach Surgery for Fixation and Decompression of Thoracolumbar Spinal Tuberculosis: A Retrospective Study. Journal of Spinal Disorder and Technique 2012
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How to Cite this Article: Dash SK | Evaluation of Single Stage Posterolateral Decompression and Posterior Fixation in Dorsolumbar Spinal Tuberculosis: A Prospective Study | Odisha Journal of Orthopaedics & Trauma | January 2022; 43: 28-33.


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Fracture Management by Traditional Bonesetters: A Tertiary Care Hospital Based Observational Study

Vol 43 | January 2022 | page: 23-27 | Krutibash Subudhi

DOI: 10.13107/ojot.2022.v43i01.029


Authors: Krutibash Subudhi [1]

[1] Department of Orthopaedic Surgery, SCB Medical College and Hospital, Cuttack, Odisha, India.

Address of Correspondence

Dr. Krutibash Subudhi,
Department of Orthopaedic Surgery, SCB Medical College and Hospital, Cuttack, Odisha, India.
E-mail: krutibashdada@gmail.com


Abstract


Background: Fracture of bone is a persistent problem encountered in orthopaedic practice. The management of fracture of bone depends on reduction and immobility at the fracture site. The traditional bone setters formulate their own methods and practices for the management of fracture. This age-old art has not only survived since ages but also flourished with time and moreover to our surprise is challenging modern orthopaedic science in many ways.
Aim of study: To find out various outcomes of fracture management by traditional bonesetters and the possible reason for their high patronage.
Methods: Present study was conducted on patients with some kind of prior treatment received from TBS. The detailed history was collected about age, sex, socioeconomic condition, education, habit and habitats from each patient. Each case was subjected to detailed clinical and radiological examinations to evaluate the outcomes of the interventions of TBSs.
Results: One hundred and fifty patients in the age group of (1–70) years were included in the study out of which 103 (69%) are male and 47 (31%) are females. 33% belong to age group of 30-45 years and 54% are of literate and fair socio-economic status. Malunion is the predominant form of presentation with 69 cases (46%) followed by non-union in 30 (20%) cases. 41 cases (28%) presented with impending ischemia at initial stages of treatment. Only 9 cases (6%) were presented with chronic osteomyelitis and infected non-union. Eventually 7 cases were ended with gangrene and amputation. Cost of surgery was the major cause (43%) followed by fear of surgery (23%) was observed for non-acceptance of modern orthopaedic system.
Conclusion: The results in our study vindicate the fact that TBS play a major role in providing health care to the fracture patients. Lack of basic knowledge and aversion to referral system by TBS is responsible for complications. So, creating public awareness and integrating TBS in the healthcare system through proper training and due legislation seems to be the apt solution to combat this menace.
Keywords: Traditional Bone Setters, chronic osteomylitis, Malunion and nonunion


References


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7. Umaru RH, Gali BM and Ali N. Role of inappropriate traditional Splintage in limb amputation in Maiduguni Nigeria. Journal of African Medicine.2004;3(3): 138-140.
8. Oginni LM. The use of Traditional fracture splint for bone setting. Nig Medical Practitioner 1992; 24 (3): 49 – 51.
9. Onuminya JE, Onabowale BO, Obekpa PO, Ihezue CH. Traditional Bonesetter’s Gangrene. International Orthopedics (SICOT) (1999); 23:111-112.
10. Khan AA. Treatment of Fractures of Long Bone by Cast Brace Method. Journal Of Bangladesh Ortho. Society 1981; 1(1): 19- 22.
11. Omololu B, Ogunlade S and Alonge T. The Complications seen from the treatment by traditional bone setters. WAJM. 2002; 21(4) : 335-337.
12. Chowdury M, Khandkher H, Ahsan, K and Mostafa D. Complications of Fracture Treatment by Traditional Bonesetters at Dinajpur, Dinajpur Medical Journal. 2011; 4 (1):15-19.
13. Nwadiaro H, Nwadiaro P, Kidmas, A, Ozoilo K. Outcome of traditional bone setting in the Middle belt of Nigeria. Nigerian Journal of Surgical Research. 2006; 8(1) :44-48.
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15. Thanni, L., Tade, A. Extremity amputation in Nigeria a review of indications and mortality.The Surgeon 2007; Volume 5 (4): 213-217.
16. Ikpeme IA, Udosen AM, Okereke, Okpa I. Patients Perception of traditional Bones Setting in Calabar. Port Harcourt Med J. 2007;1:104-7.
17. Dada A, Giwa SO, Yinusa W, Ugbeye M, Gbadegesin S: Complications of Treatment of Musculoskeletal Injuries byBone Setters, WAJM: 2009; 28(i) :43 – 47.
18. World health organization. Promoting the role of traditional medicine in health systems: a strategy for the African region (2001-2010); World health organization 2000; (document reference AFR/ RC50/ Doc.9/R).


How to Cite this Article: Subudhi K | Fracture Management by Traditional Bonesetters: A Tertiary Care Hospital Based Observational Study | Odisha Journal of Orthopaedics & Trauma | January 2022; 43: 23-27.

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An Analysis of Functional Outcome and Factors Influencing the Outcome in Floating Knee Injuries

Vol 43 | January 2022 | page: 20-22 | Ram Gopal Panigrahi

DOI: 10.13107/ojot.2022.v43i01.028


Authors: Ram Gopal Panigrahi [1]

[1] Department of Orthopaedic Surgery, SCB Medical College and Hospital, Cuttack, Odisha, India.

Address of Correspondence

Dr. Ram Gopal Panigrahi,
Department of Orthopaedic Surgery, SCB Medical College and Hospital, Cuttack, Odisha, India.
E-mail: ramgopalpanigrahi@gmail.com


Abstract


Background: The objective of the study is to study the Functional outcome and factors influencing the outcome in Floating Knee Injuries.
Methods: The study was conducted on patients in department of orthopaedics in S.C.B medical college & hospital from December 2018 to December 2020 who are admitted with Floating Knee Injuries. Detailed history were obtained using study proforma a thorough musculoskeletal examination of both the knees will be done including neuro-vascular status and appropriate radiographs and if necessary CT scan will be done. Collection of Data of the patients were by brief history of injury, systemic and musculoskeletal examination, radiography of thigh with hip and knee and leg with knee and ankle in standard antero-posterior and Lateral View, follow up with radiological and clinical parameters. Clinical follow-up will be done at 2 weeks, 4 weeks, 8 weeks, 4 months, 6 months, 12 months intervals regarding union of fractured bone, assessment of range of motion of knee, pain on weight bearing.
Results: In our study we found males are affected in 33 out of 34 patients (97%), right lower limb was involved in 28 out of 34 patients (82%),majority of the patients were of young age group between 16-40 years (60%),twenty five out of 34 patients (73%) had type I floating knee injury and 9out of 34 (27%) had type II floating knee injury, in most of the cases (70%) surgery was performed within 1 week of trauma. Knee stiffness was more common in older patients, communited fractures, Poor articular reduction. The communited fractures and poor articular reduction correlated significantly with malunion of fractures. Communited fractures were a statistically significant variable for Shortening. Open fractures, communited fractures and segmental fractures are statistically significant for non-union and delayed union.
Conclusion: Floating knee injuries are due to high velocity motor vehicle accident. Men are affected more than women. The right-side injury is more frequent than the left side. 55% of patients in this study had an excellent and good functional outcome and 45% of patients had a fair or poor functional outcome. Local complications like wound infection seen in 17.1% of patients A communited fracture is the most common predictor affecting the functional outcomes like Knee stiffness, shortening, and time to union. The other predictors affecting the functional outcomes are poor articular reduction, open fractures, segmental fractures, older age and. The time to union of tibia is more than that of femur. Revision fixation for tibial fractures was more frequent than femoral fractures.
Keywords: Floating knee, Knee injury, Functional outcome


References


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2. Hung SH, Surgical treatment of Type II floating Knee : Comparisons of the results of type IIA and type II B floating knee; Official journal of the ESSKA [Knee Surg Sports Traumatol Arthrosc], 2007 May; Vol.15(5), PP. 578-86; PMID : 17203298.
3. Dwyer AJ, Paul R, Floating Knee injuries ; Long term results of four treatment methods; International Orthopedics; 2005 Oct; Vo. 29(5), pp. 314-8; PMID : 16132984.
4. RIOS JA, Floating knee injuries treated with single incision technique versus traditional anterograde femur fixation. American Journal of Orthopedics; 2004 Sep; Vol. 33 (9), pp. 468-72; PMID : 1509113
5. Adanson GJ, Wiss DA, Lowery GL, Peters CL, Type II floating knee: Ipsilateral femoral and tibial fractures with intra-articular extension into knee joint; [J.Orthop.Trauma]; 1992; Vol. 6 (3), pp. 333-9.
6. Anastopopulous G, Assimakolopous A, Exarchou E, Ipsilateral fractures of the femur and tibia; 1992; Vol. 23(7); pp. 439-1.
7. Anil Agarwal Floating injuries: review of the literature and proposal for a universal classification; Acta Orthop Beig; 2004 Dec.
8. Bansal F. Singhal V, The floating knee. 40 cases of Ipsilateral fractures of the femur and tibia Mam M.K.; Int. Orthopedics; 1984; Vol. 8(3), pp183-7.
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21. Omer G.E., Moll J.H., Bacon W.L., Combined fractures of femur & tibia in single extremity, J. Trauma, 1968; Vol. 8, pp.1026-1041.
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24.Muñoz Vives J, Bel JC, Capel Agundez A, Chana Rodríguez F, Palomo Traver J, Schultz-Larsen M, Tosounidis T. The floating knee: a review on ipsilateral femoral and tibial fractures. EFORT Open Rev. 2016 Nov;1(11):375-382. [PMC free article] [PubMed]
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27. Carta S, Riva A, Fortina M, Colasanti GB, Meccariello L. The Challenges of the Femoral Bone Loss in the Management of the Floating Knee IIB According Fraser: A Case Report. J Orthop Case Rep. 2018 Jan-Feb;8(1):3-7. [PMC free article] [PubMed]


How to Cite this Article: Panigrahi RG | An Analysis of Functional Outcome and Factors Influencing the Outcome in Floating Knee Injuries | Odisha Journal of Orthopaedics & Trauma | January 2022; 43: 20-22.

 


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Functional Outcome of Total Knee Replacement in Osteoarthritic Knee with Fixed Flexion Deformity

Vol 43 | January 2022 | page: 14-19 | Debi Prasad Nanda

DOI: 10.13107/ojot.2022.v43i01.027


Authors: Debi Prasad Nanda [1]

[1] Department of Orthopedics, S.C.B. Medical College and Hospital, Cuttack, Odisha, India.

Address of Correspondence

Dr. Debi Prasad Nanda,
Department of Orthopedics, S.C.B. Medical College and Hospital, Cuttack, Odisha, India.
E-mail: drdebiortho@gmail.com


Abstract

Osteoarthritis gradually leads to a flexion deformity which could be attributed to either soft tissue contractures or bony blocks due to proliferating abnormal osteophytes after which surgical intervention is advocated. The different surgical options which exist are high tibial osteotomy, proximal fibular osteotomy, and knee replacement which could be unicondylar or Total. Amongst all these Total Knee replacement (TKR) provides a way to overcome all afflictions of arthritis. A prospective study was conducted in the department of orthopaedics in S.C.B medical college & hospital from October 2018 to October 2020 in 30 Patients who presented with a flexion deformity of the knee due to osteoarthritis. The mean age of the patients was 55.8±6.25 years (range 44-69). The disease is more common in the geriatric age group patients with the highest proportion (36.67%) cases in the 56-60 years age group. The male to female ratio was almost 1:2. The left knee was found slightly more affected 16(53%) than the right knee 14 (47%). Most of the patients 18 (60%) were in KL Stage III Osteoarthritis which signifies the negligence on part of the patient in seeking early medical care. The mean knee range of motion in flexion was 86.6⁰ ± 10.5⁰ (range 68-110). Additional Varus deformity was seen in 10 (33.3%) cases. No cases of valgus deformity were found in our study. The difference between the means of pre and post-op FFD is 21.9(18.37-25.42, 95% CI). The difference between the means of pre and post-op scores is 41.3 (35.0-47.5, 95% CI). The difference between the means of pre and post-op scores is 43.19 (37.0-49.3, 95% CI). In an Indian scenario where the patient comes late with gross varus and fixed flexion deformity, Posterior Cruciate Sacrificing Total Knee Replacement will give greater mobility and stability, so it can be the preferred mode of management. This implies the universality of Total Knee Arthroplasty as the Gold standard in the treatment of Osteoarthrosis of knee cutting across demographic variation and socio-economic distributions.
Keywords: Total flexion deformity, Total knee replacement, Osteoarthritis, Functional outcome

 


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3. Hwang YS, Moon KP, Kim KT, Kim JW, Park WS. Total Knee Arthroplasty for Severe Flexion Contracture in Rheumatoid Arthritis Knees. Knee Surg Relat Res.2016;28(4):325-329.
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8. Chethan VS, Tomichan MC. Functional outcome in total knee replacement. J. Evid. Based Med. Healthc. 2018; 5(35), 2550-2555.
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11. Felson DT, Naimark A, Anderson J, Kazis L, Castelli W, Meenan RF. The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study. Arthritis Rheum. 1987;30(8):914-918.
12. Cheng K,Ridley D,Bird J,McLeod G: Patients with fixed flexion deformity after total knee arthroplasty do just as well as those without:ten-year prospective data; International Orthopaedics (SICOT) (2010) 34:663–667
13. Harato K, Nagura T, Matsumoto H, et al. Extension limitation in standing affects weight-bearing asymmetry after unilateral total knee arthroplasty. J Arthroplasty 2010;25:225–229.


How to Cite this Article: Nanda DP | Functional Out come of Total Knee Replacement in Osteoarthritic Knee with Fixed Flexion Deformity | Odisha Journal of Orthopaedics & Trauma | January 2022; 43: 14-19.

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A Retrospective Analysis of Functional and Radiological Outcome of Different Modalities of Treatment of Fracture of Distal Radius

Vol 43 | January 2022 | page: 05-09 | Soumendra Kumar Majhi

DOI: 10.13107/ojot.2022.v43i01.025


Authors: Soumendra Kumar Majhi [1]

[1] Department of Orthopaedics, Sri Rama Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India.

Address of Correspondence

Dr. Soumendra Kumar Majhi,
Department of Orthopaedics, Sri Rama Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, India.
E-mail: kmsoumendra@gmail.com


Abstract

Background: Fractures of the distal radius remain the most common fractures approximately one-sixth of all fractures treated in emergency departments. There are three main peaks of fracture distribution: the first peak is in children ages 5 to 14, the second is in males under age 50 and the third peak is in females over the age of 40 years. Risk factors are – decreased bone mineral density, female gender, ethnicity, heredity & early menopause have all been shown to be risk factors for this injury. The outcome of these fractures is not uniformly good regardless the treatment instituted. A thorough understanding of the anatomy & biomechanics of the wrist is a prerequisite when treating these lesions. There is a strict relationship between the quality of anatomical reconstruction & the long-term functional outcome. No single treatment is the solution for every type of fracture in every kind of patient. Based on the functional anatomy, we analyze the actual treatment possibilities & try to develop strategies in the choice of treatment for different fracture types in different patient groups.
Materials and Methods: 92 Patients with extra-articular distal radius fractures were studied retrospectively. 30 were treated with conservative management and 62 with surgical management. Out of 62 cases treated surgically, 11 were managed by Plate osteosynthesis, 27 with Ligamentotaxis with External fixator & 24 with K wire fixation using Kapandji method at Department of Orthopaedics, Sri Rama Chandra Bhanja Medical College and Hospital, Cuttack, Odisha, since July 2018 to November 2020.
Results: The association of individuals anatomical parameters with the functional results was measured by Chi-square test of association and Odds ratio with the criteria of Stewart et al. taken as base line for comparison. This study showed a significant association of dorsal angulation < 10° and loss of radial inclination of < 9° with functional results, P < 0.001 also with loss of radial height < 6 mm, P < 0.001 (0.005). On reviewing literature only few articles were found determining values of individual radiological parameters for better functional outcome specially Smilovic et al. (2003) and few of them noted which parameters affect the function most but not determining the values for them.
Conclusion: There was no significant difference in the functional outcome of conservative treatment in comparison to various surgical modalities namely plate osteosynthesis, ligamentotaxis and k wire reduction with Kapandji method in case of extra articular and partial articular fractures of distal radius. Therefore, we cannot generalize one treatment method for all fracture patterns and treatment should be individualized to a particular fracture.
Keywords: Distal radius fracture, Radiological outcome, Functional outcome


References


1. Canale & Beaty. Campbell’s Operative Orthopaedics. 13th edn. Vol III: Page 3441- 3453.
2. Bucholz, Robert W, Heckman, James D, Court-Brown, Charles M: Fractures of distal radius & ulna: Rockwood & Green’s Fractures in Adults, 6th edition: Chapter 26: Page 910-962.
3. Gray, Henry( 1825–1861). Anatomy of the human body, by Henry Gray. 40th edn. Section – 6 : chapter – 50 : Page 870 – 876.
4. Maruan Haddad, Guy Rubin, Michael Soudry & Nimrod Rozen. External Fixation for the treatment of intra-articular Fractures of the distal radius: short- term results. IMAJ. July 2010; VOL 12
5. David L Nelson. How to classify distal radial fractures – a report. eRADIUS International Distal Radius Fracture Study Group, IFSSH Bone & Joint Committee. Nov 2006. www.eradius.com.
6. Grahm T J. Surgical correction of mal-united distal radius. Jr. Academic Orthopaedic Surgery.1995; 5: 270-281.
7. Koji Fujii, Tatsuhiko Henmi, Yoshiji Kanematsu, Takuya Mishiro, Toshinori Sakai & Tomoya Terai. Fractures of the distal end of radius in elderly patients: A comparative study of anatomical & functional results. Journal of Orthopaedic Surgery 2002, 10(1): 9–15
8. Joy C Macdermid. The Patient-Rated Wrist Evaluation (PRWE) User Manual. School of Rehabilitation Science. December 2007
9. S. Nijs, P. L. O. Broos. Fractures of the Distal Radius : a Contemporary Approach. Acta chir belg, 2004; 104: 401-412.
10. Altissimi M, Antenucci R, Fiacca C, Mancini GB. Long-term results of conservative treatment of fractures of the distal radius. Clin Orthop Relat Res. 1986 May; (206):202-10.
11. Frankie Leung, Dokuz Eylul, Shew Ping Chow. Conservative treatment of intra- articular fractures of the distal radius — factors affecting functional outcome. Hand Surgery. December 2000; Volume 05: Issue 02.
12. Carrozzella J, Stern PJ. Treatment of comminuted distal radius fractures with pins & plaster. Hand Clinic. 1988 Aug; 4(3): 391-7.
13. Kongsholm-J, Olerud-C. Plaster cast versus external fixation for unstable intra- articular Colles’ fractures. Clin Orthop Relat Res. April 1989 ; 57-65AB.
14. Jakim I, Pieterse HS, Sweet MB. External fixation for intra-articular fractures of the distal radius. J Bone Joint Surge Br. 1991 Mar; 73(2): 302-6.
15. Fernandez DL, Geissler WB. Treatment of displaced articular fractures of the radius. Journal of Hand Surgery. 1991 May; 16(3):375-84.
16. Arora J, Kapoor H, Malik A, Bansal M. Closed reduction & plaster cast immobilization vs. external fixation in comminuted intra-articular fractures of distal radius. IJO. 2004 ; Vol 38 : Issue : 2 : Page : 113-117.
17. Bartosh-R-A., Saldana. Intra-articular fractures of the distal radius: a cadaveric study to determine if ligamentotaxis restores radio-palmar tilt. J-Hand-Surg- [Am]. 1990 Jan. 15(1). P 18-21.
18. Horesh Z, Volpin G, Hoerer D, Stein H. The surgical treatment of severe comminuted intra-articular fractures of the distal radius with the small AO external fixation device. A prospective three-and-one-half-yr follow-up study. Clin Orthop Relat Res. 1991 Feb; (263):147-53.
19. Helen HG Handoll, James S Huntley, Rajan Madhok. External xation versus conservative treatment for distal radial fractures in adults. Cochrane Database of Systematic Reviews 2007, Issue 3.
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23. Charles S. Day, Atul F. Kamath, Eric Makhni, Jerome Jean-Gilles, David Zurakowski. “Sandwich” Plating for Intra-articular Distal Radius Fractures with Volar & Dorsal Metaphyseal Comminution. Hand. 2008 March; 3(1): 47–54.
24. Herdrich S, Bauer J, Pichl J, Hoffmann R. Management of complex intra- articular distal radius fractures with open reduction & internal fixation with double dorsal locking plates. Z Orthop Unfall. 2010 Jan;148(1):72-9.
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How to Cite this Article: Majhi SK | A Retrospective Analysis of Functional and Radiological Outcome of Different Modalities of Treatment of Fracture of Distal Radius | Odisha Journal of Orthopaedics & Trauma | January 2022; 43: 05-09.

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From The Editors Desk…

Vol 43 | January 2022 | page: 04 | Satya Ranjan Patra

DOI: 10.13107/ojot.2022.v43i01.024


Authors: Satya Ranjan Patra [1]

[1] Department of Orthopaedics, Health Village Hospital, Bhubaneswar Odisha, India.

Address of Correspondence

Dr. Satya Ranjan Patra,
Chief Consultant, Department of Orthopaedics, Health Village Hospital, Bhubaneswar Odisha, India.
E-mail: ojot.editor@gmail.com


From The Editor’s Desk…..

Our editorial team has always endeavoured not just to improve the quality of the manuscripts but also to help the authors improve their writing skills. Depending upon the type of manuscript we recommend standard guidelines like the CONSORT, PRISMA, STROBE, CARE and STARD. We also recommend IMRaD format while writing the manuscript.
The Introduction, which is around 3-4 paragraphs, should be structured from generalities to the specific elaborating what the shortcomings are in published literature and what void the current research would fill. The authors must understand that the “aim” is the broader intent, while the “objectives” are the more specific steps which one plans to achieve.
The Material and Methods section needs to be detailed to such an extent that any researcher planning to replicate the study can do so with accuracy. In this section, the study design, the study setting, inclusion and exclusion criteria, sample size, interventions, outcome measures and statistics are elaborated.
The results section provides outcome data about primary and secondary measures as well as the contrast between groups wherever applicable. Avoid presenting same result data in multiple formats as well as interpreting the results in this section.
The discussion part compares the results with existing literature, analyses the strengths and limitations of the study and at the same time explain the practical implications as well as future research directions. Finally, at the end a summary of the concluding findings should be provided and whether they support your initial research hypothesis.
Last but not the least, the author must remember the criticality of the abstract. Most reviewers and editors as well as readers base their initial judgement based on this short paragraph. Structured abstracts are preferred with relevant subsections. Authors must understand the significance of keywords, MeSH terms as well as how to do proper referencing.
Writing medical literature is an art which needs to be groomed at an early stage. Competency develops as one writes more & more. We hope this editorial will help authors understand how to ensure that their article is selected, printed, and finally appreciated by the readers.
We end this editorial with a remembrance to a few of our dearest fellow Orthopaedicians whose demise shall leave a lasting void in Odisha Orthopaedics. Dr Prabhakar Mohanty, Dr Bijay Kumar Sadangi, Dr Binay Aggarwal and Dr Smarajit Pattnaik will always be in our cherished memories.

Dr Satya Ranjan Patra
Editor – In – Chief


How to Cite this Article: Patra SR | From The Editor’s Desk | Odisha Journal of Orthopaedics & Trauma | January 2022; 43: 04.

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