Comparison of the Outcomes of Intra-articular Distal Femur Fracture Managed With Distal Femoral Nail and Locking Compression Plate: A Prospective Study

Vol 42 | Issue 1 | January-June 2021 | page: 12-15 | Manoranjan Mallick, Gopal Chandra Sethi, Abinash Ray, Debi Prasad Nanda


Authors: Manoranjan Mallick [1], Gopal Chandra Sethi [1], Abinash Ray [1], Debi Prasad Nanda [1]

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

Address of Correspondence

Dr. Debi Prasad Nanda,
SCB Medical College, Cuttack, Odisha, India.
E-mail: drdebiortho@gmail.com


Abstract

Background: The treatment of intraarticular distal femur fracture still remains a debatable issue. The need for anatomical reduction and maintenance of the joint congruity while giving the patient a painless mobile knee is quite challenging. There is little Indian literature evidence comparing the functional outcome after treatment with distal femoral nail and locking compression plate in these group pf fractures. We decide to clear this gap in knowledge by this current study.
Material and methods: This was a prospective study Of 20 patients with closed intra-articular distal femoral fracture treated either with distal femoral nail and locking compression plate. It was carried out in the Department of Orthopaedics, SCB Medical College, and Cuttack during the period of August 2017 to November 2019 and functional results are analysed with 100 point scores by Neer et al i.e. Neer’s criteria.
Result: Average healing time was better in the case of nailing (15.2 weeks) than plating (18 weeks) which was assessed both clinically and radiologically. The average knee flexion range of motion was better in the case of nailing (112°)than plating (93°). With Neer’s score, an Excellent result was obtained in 90% cases in nailing comparing to only 30% with plating where a fair and poor result was obtained in 10% cases in nailing comparing to 70% with plating.
Conclusion: In the present study, retrograde nailing was found to be a better fixation system for both extra as well as intra-articular fractures(type C1 & type C2) of distal femur with better outcome in terms of range of movements, early mobilization, union and less operative time and blood loss.
Keywords: Intra-Articular Fractures; Bone Plates; Range of Motion; Articular.


References

1. Arneson TJ, Melton LJ 3rd, Lewallen DG, et al. Epidemiology of diaphyseal and distal femoral fractures in Rochester, Minnesota, 1965-1984. Clin orthop.1988;234:188-94.
2. Schandelmaier P, Partenheimer A, Koenemann B, et al. Distal femoral fractures and LISS stabilization. Injury 2001; 32 Suppl 3:SC55-63.
3. Gurkan V, Orhun H, Doganay M, Salioğlu F, Ercan T, Dursun M, et al. Retrograde intramedullary interlocking nailing in fractures of the distal femur. Acta Orthop Traumatol Turc. 2009; 43:199-205.
4. Smith WR, Ziran BH, Anglen JO, Stahel PF. Locking plates: tips and tricks. J Bone Joint Surg Am. 2007; 89(10):2298-307.
5. Markmiller M, Konrad G, Südkamp N: Femur-LISS and distal femoral nail for fixation of distal femoral fractures: are there differences in outcome and complications? Clin Orthop Relat Res. 2004; 426:252-257.
6. Lujan TJ, Henderson CE, Madley SM, Fitzpatrick DC, Marsh JL, Bottlang M. Locked plating of distal femur fractures leads to inconsistent and asymmetric callus formation. J Orthop Trauma. 2010; 24:156-62.
7. Herrera DA, Kregor PH, Cole PA, Levy B, Jonsson A, Zlowodzki M. Treatment of acute distal femur fractures above a total knee arthroplasty: Systematic review of 415 cases (1981-2006) Acta Orthopaedics. 2008; 79(1):22-27
8. Gao K, Gao W, Huang J, Li H, Li F, Tao J, Et Al. Retrograde Nailing Versus Locked Plating Of Extra-Articular Distal Femoral Fractures: Comparison Of 36 Cases. Med Princ Pract. 2013; 22:161-66.
9. Neer II CS, Grantham SA, Shelton ML. Supracondylar Fracture of the Adult Femur. The Journal of Bone & Joint Surgery. 1967; 49A:591-613.
10. Henderson CE, Lujan TJ, Kuhl LL, Bottlang M, Fitzpatrick DC, Marsh JL. Healing Complications Are Common After Locked Plating for Distal Femur Fractures. ClinOrthopRelat Res 2011 June; 469(6): 1757-1765
11. Markmiller M, Konrad G, Sudkamp N. Femur-LISS and distal femoral nail for fixation of distal femoral fractures: are there differences in outcome and complications? ClinOrthopRelat Res. 2004; (426):252-257
12. Kumar A, Jasani VM Butt MS. Management of distal femoral fractures in elderly patients using retrograde titanium supracondylar nails. Injury, 31(3): 169-73, Apr 2000
13. Ingman AM. Retrograde intramedullary nailing of supracondylar femoral fractures: Design & Development of a New Implant. Injury, 33(8); 707-12: Oct 2002
14. Leggon RE, Feldmann DD. Retrograde Femoral Nailing: A Focus On The Knee. Am J Knee Surg. 2001; 14:109-118.
15. Hoskins W, Sheehy R, Edwards ER, Hau RC, Bucknill A, Parsons N, Griffin XL. Nails or plates for fracture of the distal femur? Bone Joint J. 2016; 98-B:846-50.

How to Cite this Article: Mallick M, Sethi GC, Ray A, Nanda D| Comparison of the Outcomes of Intra-articular Distal Femur Fracture Managed With Distal Femoral Nail and Locking Compression Plate: A Prospective Study | Odisha Journal of Orthopaedics & Trauma | January-June 2021; 42(1): 12-15.

(Abstract) (Full Text HTML)      (Download PDF)


 

 

 

 

 

 

 

 

 

 

 

 

 

Short Term Outcomes of Tumor Resection and Reconstruction by Megaprosthesis Around Knee: An Analysis with Review of Literature

Vol 42 | Issue 1 | January-June 2021 | page: 34-36 | Bikram K Kar, Mukund M. Ojha, Sandeep Kumar Yadav, Alok Chandra Agrawal, Harshal Sakale


Authors: Bikram K Kar [1], Mukund M. Ojha [1], Sandeep Kumar Yadav [1], Alok Chandra Agrawal [1], Harshal Sakale [1]

[1] Department of Orthopaedics, AIIMS Raipur, Chattisgarh, India.

Address of Correspondence

Dr. Mukund M. Ojha,
AIIMS Raipur, Chattisgarh, India.
E-mail: mukund1203@gmail.com


Abstract

In this modern era, limb reconstructive surgeries have become a standardized procedure for malignant tumour of lower limbs. We performed limb salvage surgeries for tumour around the knee with en-bloc resection and subsequent reconstruction with a mega prosthesis. A total of six cases of malignant and locally aggressive tumour around the knee were operated, on from 2017 to 2018, with resection and mega prosthetic reconstruction. Interpretation of functional outcome after surgery was performed with musculoskeletal tumour society score (MSTS). Complications like infection, local recurrence of tumour, implant failure and distant metastases were evaluated during each follow up. Postoperatively, one patient developed superficial infection; the rest cases were uneventful. Patients were regularly followed for one year, and none of them developed any sign of deep infection, local recurrence of tumours, implant failure or distant metastases. At the beginning of treatment, the average MSTS score was 8.83, which showed a significant increment to 25.83 after 12 months of follow up. Albeit few cases were operated on, we draw this inference from our short term experience that mega prosthesis acts as a boon to orthopaedic surgeons in musculoskeletal tumour management, thereby uplifting the quality of life of patients.
Keywords: Limb salvage surgery; Osteosarcoma; Giant cell tumour; Megaprosthesis.


References

1. Chauhan A, Joshi GR, Chopra BK, Ganguly M, Reddy GR. Limb salvage surgery in bone tumors: a retrospective study of 50 cases in a single center. Indian J Surg Oncol. 2013;4(3):248–254. doi:10.1007/s13193-013-0229-8.
2. Ilyas I, Kurar A, Moreau PG, Younge DA. Modular megaprosthesis for distal femoral tumors. Int Orthop. 2001;25 (6):375–377. doi: 10.1007/s002640100290.
3. Orlic D, Smerdelj M, Kolundzic R, Bergovec M. Lower limb salvage surgery: modular endoprosthesis in bone tumor treatment. Int Orthop. 2006;30(6):458–464. doi:10.1007/s00264-006-0193-9
4. Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res. 1980;(153):106–120.
5. Van der Heijden L, Dijkstra PD, van de Sande MA, et al. The clinical approach toward giant cell tumor of bone. Oncologist. 2014; 19(5):550–561. doi:10.1634/theoncologist.2013-0432
6. Gkavardina A, Tsagozis P. The use of megaprostheses for reconstruction of large skeletal defects in the extremities: a critical review. Open Orthop J. 2014;8:384–389. Published 2014 Oct 17. doi:10.2174/1874325001408010384.
7. https://www.rtog.org/LinkClick.aspx?fileticket=zPqFk5qbR5I%3D&tabid=40.
8. Kamal AF, Rubiansyah P. Clinical outcome of various limb salvage surgeries in osteosarcoma around knee: Megaprosthesis, extracorporeal irradiation and resection arthrodesis. Ann Med Surg (Lond). 2019;42:14–18. Published 2019 Apr 24. doi:10.1016/j.amsu.2019.04.005.
9. Tiwari A, Jain S, Mehta S, Kumar R, Kapoor G, Kumar K. Limb salvage surgery for osteosarcoma: Early results in Indian patients. Indian J Orthop. 2014;48(3):266–272. doi:10.4103/0019-5413.132511.
10. Xu M, Peng D, Peng H, Chen X, Li Z, Li Z. Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2010;35(3):267–272. doi:10.3969/j.issn.1672-7347.2010.03.013
11. Kamal AF, Muhamad A. Outcomes of En bloc resection followed by reconstruction of giant cell tumor around knee and distal radius. A case series. Ann Med Surg (Lond). 2019;49:61–66. Published 2019 Dec 6. doi:10.1016/j.amsu.2019.11.019.
12. Kapoor SK, Thiyam R. Management of infection following reconstruction in bone tumors. J Clin Orthop Trauma. 2015;6(4):244–251. doi:10.1016/j.jcot.2015.04.005.

How to Cite this Article: Kar BK, Ojha MM, Yadav SK, Agrawal AC, Sakale H | Short Term Outcomes of Tumor Resection and Reconstruction by Megaprosthesis Around Knee: An Analysis with Review of Literature | Odisha Journal of Orthopaedics & Trauma | January-June 2021; 42(1): 34-36.

(Abstract) (Full Text HTML)      (Download PDF)


 

 

 

 

 

 

 

 

 

 

 

 

 

Cemented Total Hip Arthroplasty with Sub trochanteric Femoral Shortening Osteotomy, a Cost-effective Procedure to Manage Advanced Osteoarthritis of Hip Joint: A Case report and Review of Literature

Vol 42 | Issue 1 | January-June 2021 | page: 31-33 | Sunil Kumar Dash, Rabindra Kumar Mohapatra, Abhimanyu Madhual, Srikant Mishra, Bibhudutta Mall, Priti Ranjan Patra


Authors: Sunil Kumar Dash [1], Rabindra Kumar Mohapatra [1], Abhimanyu Madhual [1], Srikant Mishra [1], Bibhudutta Mall [1], Priti Ranjan Patra [1]

[1] Department of Orthopaedics, Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha, India.

Address of Correspondence

Dr. Bibhudutta Mall,
Hi-Tech Medical College and Hospital, Bhubaneswar, Odisha, India.
E-mail: bibhuduttamall_013@live.com


Abstract

A 60-year-old male had a history of Avascular Necrosis (AVN) with advanced secondary osteoarthritis of both hip joints. Total Hip Arthroplasty (THA) concomitant with subtrochanteric femoral shortening osteotomy using a cemented stem was performed. The subtrochanteric osteotomy was performed with an amount of osteotomy equal to the amount of distal translation of the hip centre to the original acetabulum. The pelvic obliquity improved, and the subjective leg length discrepancy disappeared after the surgery.
Keywords: Cemented total hip arthroplasty; Subtrochanteric femoral shortening osteotomy; Open reduction and internal fixation.


References

1. Noble PC, Kamaric E, Sugano N, Matsubara M, Harada Y, Ohzono K, Paravic V. ; Three-dimensional shape of the dysplastic femur: implications for THR. ClinOrthopRelat Res. 2003; 417: 27–40.
2. Bao N, Meng J, Zhou L, Guo T, Zeng X, Zhao J.; Lesser trochanteric osteotomy in THA for treating CROWE type-IV developmental dysplasia of hip. IntOrthop. 2013; 37(3):385–390. doi: 10.1007/s00264-012-1758-4
3. David J.YasgurSteven, A.StuchinEdward M.Adler, Paul E.DiCesare; Subtrochanteric femoral shortening osteotomy in THA for high-riding DDH; The Journal of ArthroplastyVolume 12, Issue 8, December 1997, Pages 880-888
4. Charity JAF, Tsiridis E, Sheeraz A, et al. Treatment of Crowe IV high hip dysplasia with THA using the Exeter stem and shortening derotational subtrochanteric osteotomy. J Bone Joint Surg Br 2011;93B:34–8.
5. Kawai T, Tanaka C, Ikenaga M, et al. Cemented total hip arthroplasty with transverse subtrochanteric shortening osteotomy for Crowe grope IV dislocated hip. J Arthroplasty 2011;26:229–35.
6. Sonohata M, Tajima T, Kitajima M, et al. Total hip arthroplasty combined with double-chevron subtrochanteric osteotomy. J OrthopSci 2012;17:382–9.
7. Gurney B. Leg length discrepancy; Gait Posture 2002; 15:195–206
8. Bizzard D, Nickel BT, Seyler TM, et al. The impact of lumbar spine disease and deformity on total hip arthroplasty outcomes; OrthopClini N Am 2016;47:19–28

How to Cite this Article: Dash SK, Mohapatra RK, Madhual A, Mishra S, Mall B, Patra PR | Cemented Total Hip Arthroplasty with Sub trochanteric Femoral Shortening Osteotomy, a Cost-effective Procedure to Manage Advanced Osteoarthritis of Hip Joint: A Case report and Review of Literature | Odisha Journal of Orthopaedics & Trauma | January-June 2021; 42(1): 31-33.

(Abstract) (Full Text HTML)      (Download PDF)


 

 

 

 

 

 

 

 

 

 

 

 

 

Functional Outcome of Tripled Semitendinous Autograft for ACl Reconstruction: A Retrospective Study

Vol 42 | Issue 1 | January-June 2021 | page: 16-20 | Amit Das, Tapas Kumar Panigrahi


Authors: Amit Das [1], Tapas Kumar Panigrahi [1]

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

Address of Correspondence

Dr. Amit Das,
SCB Medical College & Hospital, Cuttack, Odisha, India.
E-mail: dasamit374@gmail.com


Abstract

Hamstring tendons have become the most accepted grafts for ACL reconstruction. Harvesting only semi-T instead of SemiT-G from the pes anserinus can reduce the deficit of the knee flexor strength and improve the functional recovery without weakening the reconstructed ligament. A Retrospective study was conducted on 63 patients who underwent anatomical ACL reconstruction using tripled semitendinosus graft fixed with interferential screws. The average length of the Semitendinosus graft was 25cm. The cases had an average follow up upto 24 months. Functional evaluation informs radiological laxometry and objective knee scores in the forms of IKDC, Lysholm and Tegner scores. The mean Lysholm score improved from 49 (35-65) pre-op to 86 (55-100) on follow-up. The Tegner score improved from 4+1 to 5+1. The IKDC(International knee documentation committee) score improved from pre-op A=2cases, B=7, C=15, D=39 to Post-op A=28, B=22, C=10, D=3 respectively. 4 cases have pivot shift positive (6%) including 3 cases of traumatic graft ruptures at a mean age of 9.3 months. After radiological laxometry, 48 cases have anterior laxity <3mm, 6 cases have 3-5mm and 4 cases have >5 mm laxity. Tripled ST graft is an adequate graft for ACL reconstruction in the Indian population, considering the varied anthropometry and squatting habit. It obviates the need for harvesting the gracilis, yet retains adequate strength for use as an ACL graft.
Keywords: Tripled Semi Tendinosus graft; Knee scores; Gracilis.


References

1. Feller JA, Webster KE (2003) : A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. Am J Sports Med 31:564–573
2. Freedman K, D’Amato M, Nedeff D, Kaz Ari, Bach B (2003) Arthroscopic anterior cruciate ligament reconstruction: a metaanalysis comparing patellar tendon and hamstring tendon autografts. Am J Sports Med 31:2–11
3. Prodromos C (2007) The anterior cruciate ligament reconstruction and basic science. 2ST/2Gr, 4ST, and 3ST/2Gr techniques: deciding which hamstring configuration to use. Saunders, pp 110–114 .
4. Gobbi A (2010) Single versus double hamstring tendon harvest for ACL reconstruction. Sports Med Arthrosc 18(1):15–19
5. Viola RW, Sterett WI, Newfield D, Steadman JR, Torry MR (2000) Internal and external tibial rotation strength after anterior cruciate ligament reconstruction using ipsilateral semitendinosus and gracilis tendon autografts. Am J Sports Med 28:552–555
6. Tashiro T, Kurosawa H, Kawakami A, Hikita A, Fukui N (2003) Influence of medial hamstring tendon harvest on knee flexor strength after anterior cruciate ligament reconstruction. A detailed evaluation with comparison of single-and double-tendon harvest. Am J Sports Med 31(4):522–529
7. Aune A, Holm I, Risberg MA, Jensen HK, Steen H (2001) Fourstrand hamstring tendon autograft compared with patellar tendonbone autograft for anterior cruciate ligament reconstruction: a randomized study with two-year follow-up. Am J Sports Med 29:722–728
8. Bizzini M, Gorelick M, Munzinger U, Drobny T (2006) Joint laxity and isokinetic thigh muscle strength characteristics after anterior cruciate ligament reconstruction: bone patellar tendon bone versus quadrupled hamstring autografts. Clin J Sport Med 16:4–9
9. Feller JA, Webster KE (2003) A randomized comparison of patellar tendon and hamstring tendon anterior cruciate ligament reconstruction. Am J Sports Med 31:564–573
10. More RC, Karras BT, Neiman R, Fritschy D, Woo SL-Y, Daniel DM. Hamstrings – an anterior cruciate ligament protagonist: an in vitro study. AmJ Sports Med 1993;21:231±237
11. BeardDJ,KyberdPJ,FergussonCM,DoddCA.Proprioceptionafterruptureoftheanteriorcruciateligament.JBoneJointSurg 1993; 75B: 311±315
12. Ardern CL, Webster KE, Taylor NF, Feller JA (2010) Hamstring strength recovery after hamstring tendon harvest for anterior cruciate ligament reconstruction: a comparison between graft types. Arthroscopy 26(4):462–469
13. Segawa H, Omori G, Koga Y, Kameo T, Iida S, Tanaka M (2002) Rotational muscle strength of the limb after anterior cruciate ligament reconstruction using semitendinosus and gracilis tendon. Arthroscopy 18(2):177–182
14. Nakamura N, Horibe S, Sasaki S, Kitaguchi T, Tagami M, Mitsuoka T, Toritsuka Y, Hamada M, Shino K (2002) Evaluation of active knee flexion and hamstring strength after anterior cruciate ligament reconstruction using hamstring tendons. Arthroscopy 18(6):598–602
15. Nakamura N, Horibe S, Sasaki S et al: Evaluation of active knee flexion and hamstring strength after anterior cruciate ligament reconstruction using hamstring tendons. Arthroscopy, 2002; 18(6): 598–602
16. Coombs R, Cochrane T. Knee Flexor Strength Following Anterior Cruciate Ligament Reconstruction with the Semitendinosus and Gracilis Tendons. Int J Sports Med 2001; 22: 618±622
17. Riley williamsIII,JonHyman,FRankPetrigliano,TamaraRozental,THomas 1,Wickiewicz.Anterior cruciate ligament reconstruction with a four stranded hamstring tendon Autograft.Journal Of BOne and Joint surgery.volume86(2):february 2004.
18. Zysk,StefanP,KRuger,Andreus,Baur,Andrea,Vielhelmann,Andreas and Refior,Hans J.(2000).Tripled Hamstring Anterior Cruciate Ligament Reconstruction with EndobuttonFixation:A 23 year follow up study of 35 patients.Acta Orthopaedica,71:(4),381-386.
19. Lipscomb A,JohnstonK,SynderB,WarburtonJ,Gilbert P. Evaluation of hamstring strength following use of semitendinosus and gracilis tendons to reconstruct the anterior cruciate ligament.The American Journal of Sports Medicine10(6):340-342
20. Hayri Baran Yosmaoglu , Gul Baltaci ,Hamza Ozer , Ahmet Atay .Effects of additional gracilis tendon harvest on muscle torque, motor coordination, and knee laxity in ACL reconstruction.KneeSurg Sports TraumatolArthrosc (2011) 19:1287–1292
21. Williams RJ,HymanJ,PetriglianoF,RozentalT,WickiewiczTL.Anterior cruciate ligament reconstruction with a four-strand hamstring tendon autograft.J Bone Joint Surg Am(2004)feb;86(2):225-32.

How to Cite this Article: Das A, Panigrahi TK | Functional Outcome of Tripled Semitendinous Autograft for ACl Reconstruction: A Retrospective Study | Odisha Journal of Orthopaedics & Trauma | January-June 2021; 42(1): 16-20.

(Abstract) (Full Text HTML)      (Download PDF)


 

 

 

 

 

 

 

 

 

 

 

 

 

From The Editor’s Desk

Vol 42 | Issue 1 | January-June 2021 | page: 01 | Nirmal Chandra Mohapatra


Authors: Nirmal Chandra Mohapatra [1]

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

Address of Correspondence

Dr. Nirmal Chandra Mohapatra,
SCB Medical College, Cuttack, Odisha, India.
E-mail: ojot.editor@gmail.com


From The Editor’s Desk

Cataclysmic changes have shaken our world in the last year. The COVID-19 pandemic has changed the way we work as well as the way we think. Everybody had to act instantly and spontaneously. Orthopaedic training and practice were massively hit as social distancing norms set in. It was bewildering to think, how orthopaedic education for students especially postgraduates would continue under such circumstances. OJOT in a coordinated manner along with all the MS and DNB training institutes of the state started a PG Webinar series to cater to the intermediate vacuum during shutdown and lockdowns.

On the publishing front, we were already incorporating changes that would help us to continue with the journal in these uncertain times. The changes are gradual but noticeable. OJOT released its first online issue (Volume 41, issue 10) last year. From this year the journal has been converted into a biannual periodical as the number of contributions rises sharply. This issue is the first biannual release after 41 years of journal publication! The journal has gradually started being accepted by abstracting agencies. In the last six months, we received indexing from a few major agencies.

We are gradually planning a subspecialty focus to cater to future requirements. Presently we are hoping for indexing by major MCI recognised agencies. Journal guidelines are being built up to enhance the quality of submissions. The path ahead is tough, but we are confident of achieving the targets that have been put forth with sustained support from the association members.


How to Cite this Article: Mohapatra NC | From the Editor’s Desk | Odisha Journal of Orthopaedics & Trauma | January-June 2021; 42(1): 01.

(Abstract) (Full Text HTML)      (Download PDF)


 

 

 

 

 

 

 

 

 

 

 

 

 

Suprapatellar Nailing of the Tibia: Indications, Advantages, Disadvantages, Surgical tips and tricks

Vol 42 | Issue 1 | January-June 2021 | page: 08-11 | Saurav N. Nanda, Saswat Samant, Govind VJ, Ashok Gachhayat, Sumanyu Kumar Tripathy, Debashish Mishra


Authors: Saurav N. Nanda [1], Saswat Samant [1], Govind VJ [1], Ashok Gachhayat [1], Sumanyu Kumar Tripathy [1], Debashish Mishra [1]

[1] Department of Orthopaedics, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India.

Address of Correspondence

Dr. Saurav N. Nanda,
Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India.
E-mail: saurav.scb@gmail.com


Abstract

Extra-articular proximal tibial fractures account for approximately 10% of all tibial fractures. In proximal tibial shaft fractures, surgeons have struggled with inadequate maintenance of reduction, suboptimal reaming, and poor placement of the nail resulting in malalignment and further complications.The primary indication for suprapatellar nailing is probably an extra-articular proximal tibia fracture. Suprapatellar intramedullary nailing is a safe and easy method for treating extra-articular proximal tibia fractures without causing malalignment and without resorting to additional fixation methods.

Keywords: Suprapatellar nailing; Proximal tibia fracture; Nailing techniques.


References

1. Court-Brown CM, McBirnie J. The epidemiology of tibial fractures. J Bone Joint Surg Br 1995;77:417–21.
2. Attal R, Hansen M, Kirjavainen M, Bail H, Hammer O, Rosenberger R, et al. A multicenter case series of tibia fractures treated with the Expert Tibia Nail (ETN). Arch Orthop Trauma Surg 2012;132:975–84.
3. Tornetta P, Collins E. Semiextended position of intramedullary nailing of the proximal tibia. Clin Orthop Relat Res 1996;328:185–9.
4. Franke J, Hohendorff B, Alt V, Thormann U, Schnettler R. Suprapatellar nailing of tibial fractures–Indications and technique. Injury. 2016;47(2):495-501.
5. Tornetta P, 3rd, Riina J, Geller J, et al. Intra Articular anatomic risks of tibial nailing. J Orthop Trauma 1999;13:247–51
6. Cole JD. Distal tibia fracture: Opinion: intramedullary nailing. J Orthop Trauma 2006;20:73–4
7. Chen X, Xu HT, Zhang HJ, Chen J. Suprapatellar versus infrapatellar intramedullary nailing for treatment of tibial shaft fractures in adults. Medicine (Baltimore). 2018;97(32):e11799.
8. Morandi M, Banka T, Gaiarsa GP, Guthrie ST, Khalil J, Hoegler J, Lindeque BG. Intramedullary nailing of tibial fractures: review of surgical techniques and description of a percutaneous lateral suprapatellar approach. Orthopedics. 2010;33(3):172–9.
9. Song SY, Chang HG, Byun JC, Kim TY. Anterior knee pain after tibial intramedullary nailing using a medial paratendinous approach. J Orthop Trauma. 2012;26(3):172–7.
10. Jang Y, Kempton LB, TO MK, Sorkin AT. Insertion-related pain with intramedullary nailing. Injury. 2017;48(Suppl 1):S18–21.
11. Leliveld MS, Verhofstad MH. Injury to the infrapatellar branch of the saphenous nerve, a possible cause for anterior knee pain after tibial nailing? Injury. 2012;43(6):779–83.
12. Courtney PM, Boniello A, Donegan D, Ahn J, Mehta S. Functional knee outcomes in infrapatellar and suprapatellar tibial nailing: does approach matter? Am J Orthop. 2015;44(12):E513–6.
13. Gaines RJ, Rockwood J, Garland J, Ellingson C, Demaio M. Comparison of insertional trauma between suprapatellar and infrapatellar portals for tibial nailing. Orthopedics. 2013;36(9):e1155–8.
14. Chan DS, Serrano-Riera R, Griffing R, Steverson B, Infante A, Watson D, Sagi HC, Sanders RW. Suprapatellar versus infrapatellar tibial nail insertion: a prospective randomized control pilot study. J Orthop Trauma. 2016;30(3):130–4.
15. 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(3):150–4.
16. Yang, L., Sun, Y. & Li, G. Comparison of suprapatellar and infrapatellar intramedullary nailing for tibial shaft fractures: a systematic review and meta-analysis. J Orthop Surg Res 13, 146 (2018).
17. Brink O. Suprapatellar nailing of tibial fractures: surgical hints. Current orthopaedic practice. 2016;27(1):107–12.
18. Wang Z, Li SL, Wang XY, et al. Supra-patellar versus infra-patellar intramedullary nailing in treatment of tibial shaft fractures. China J Orthop Trauma 2016;18:283–9.
19. Hessmann, M.H., Buhl, M., Finkemeier, C. et al. Suprapatellar nailing of fractures of the tibia. Oper Orthop Traumatol (2020).

How to Cite this Article: Nanda SN, Samant S, Govind VJ, Gachhayat A, Tripathy SK, Mishra D | Suprapatellar Nailing of the Tibia: Indications, Advantages, Disadvantages, Surgical tips and tricks | Odisha Journal of Orthopaedics & Trauma | January-June 2021; 42(1): 08-11.

(Abstract) (Full Text HTML)      (Download PDF)


 

 

 

 

 

 

 

 

 

 

 

 

 

Total Elbow Replacement in Rheumatoid Arthritis: A Case Report

Vol 42 | Issue 1 | January-June 2021 | page: 24-27 | Amit Das, Saroj Kumar Parida


Authors: Amit Das [1], Saroj Kumar Parida [1]

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

Address of Correspondence

Dr. Amit Das,
SCB Medical College & Hospital, Cuttack, Odisha, India.
E-mail: dasamit374@gmail.com


Abstract

Inflammatory arthropathies such as Rheumatoid arthritis represent the classic indication for
Total elbow arthroplasty(TEA). Indications have been expanded to include posttraumatic
osteoarthritis, acute distal humerus fractures, distal humerus nonunions and reconstruction
after tumour resection. Elbow arthroplasty successful in terms of pain relief, motion and
function. For elderly patients with deformity and ankylosis of the elbow due to Rheumatoid
arthritis, Total Elbow Arthroplasty is one of the valuable options. Here, we present a case of a
female patient suffering from the rheumatoid elbow with significant pain, deformity and
instability. The Semi Constrained hinge type elbow prosthesis was used. Clinico-radiological
follow up was done at 1 month, 3 months, 6 months, 8 months. In the present case at follow
up, supination was 70°, pronation 70°, flexion 135°. The mean Mayo elbow performance
score was 95 points. Clinico-radiologically the elbows were stable and no evidence of
loosening was seen. Elbow arthroplasty remains a valuable option for deformed and unstable
elbows especially in selective patients with crippling deformity of the elbow.
Keywords: Rheumatoid Arthritis; Total Elbow Arthroplasty; Semi-constrained prosthesis.


References

1. Studer A, Athwal GS. Rheumatoid arthritis of the elbow. Hand Clin. 2011;27(2):139–50.
v.
2. Dyer GS, Blazar PE. Rheumatoid elbow. Hand Clin. 2011;27(1):43–8.
3. Govind P, Yogesh P. Total elbow replacement: Baksi sloppy Hinge joint. Jivisha 2011.
4. Morrey BF. Complications of elbow replacement surgery. The Elbow and its disorders. 3rd
ed, Philadelphia: WB Saunders Company; 2000. p. 667-72.
5. Quenneville CE, Austman RL, King GJ, Johnson JA, Dunning CE. Role of an anterior
flange on cortical strains through the distal humerus after total elbow arthroplasty with a
latitude implant. J Hand Surg Am 2008; 33(6): 927-31
6. Fevang BT, Lie SA, Havelin LI, Skredderstuen A, Furnes O.Results after 562 total elbow
replacements: a report from the Norwegian Arthroplasty Register. J Shoulder Elbow Surg
2009;18(3): 449-56
7. Bryan RS, Morrey BF. Extensive posterior exposure of the elbow. A triceps-sparing
approach. Clin Orthop 1982; (166): 188-92.
8. Prokopis PM, Weiland AJ. The triceps-preserving approach for semiconstrained total
elbow arthroplasty. J Shoulder Elbow Surg 2008;17(3): 454-8.
9. Alonso-Llames M. Bilaterotricipital approach to the elbow. Its application in the
osteosynthesis of supracondylar fractures of the humerus in children. Acta Orthop Scand.
1972; 43(6): 479-90
10. Figgie MP, Inglis AE, Mow CS, Figgie HE. Total elbow arthroplasty for complete
ankylosis of the elbow. J Bone Joint Surg Am. 1989; 71: 513-520.
11. Peden JP, Morrey BF. Total elbow replacement for the management of the ankylosed or
fused elbow. J Bone Joint Surg Br. 2008; 90: 1198-1204.
12. Mansat P, Morrey BF. Semiconstrained total elbow arthroplasty for ankylosed and stiff
elbows. J Bone Joint Surg Am. 2000; 82: 1260-1268.
13. Voloshin I, Schippert DW, Kakar S, Kaye EK, Morrey BF. Complications of total elbow
replacement: a systematic review. J Shoulder Elbow Surg. 2011; 20: 158-168.
14. Larson AN, Morrey BE. Interposition arthroplasty with an Achilles tendon allograft as a
salvage procedure for the elbow.J Bone Joint Surg Am 2008;90;2714-23.
15. Bernhard J, Robert A, Moorey BF. Management of acute distal humeral fractures in
patients with rheumatoid arthritis: A case Series. J Bone Joint Surg Am 2008:90:2197-205.
16. O’Driscoll SW, King GJ. Treatment of instability after total elbow arthroplasty.
Orthop Clin North Am 2001;32:679-95.
17. Kraay MJ, Figgie MP, Inglis AE, Wolfe SW, Ranawat CS. Primarysemi constrained total
elbow arthroplasty: Survival analysis of 113 consecutive cases. J Bône Joint Surg Br
1994;76:636-40
18. Prasad N, Dent C. Outcome of total elbow replacement for rheumatoid arthritis: single
surgeon’s series with Souter-Strathclyde and Coonrad-Morrey prosthesis. J Shoulder Elb
Surg/Am Shoulder Elbow Surg [et al]. 2010;19(3):376–83
19. Little C P, Graham A J, Carr A J. Total elbow arthroplasty. A systematic review of the
literature in the English language until the end of 2003. J Bone Joint Surg (Br) 2005a; 87:
437-44.

How to Cite this Article: Das A, Parida SK | Total Elbow Replacement in Rheumatoid Arthritis: A Case Report | Odisha Journal of Orthopaedics & Trauma | January-June 2021; 42(1): 24-27.

(Abstract) (Full Text HTML)      (Download PDF)


 

 

 

 

 

 

 

 

 

 

 

 

 

A Rare Case of Isolated Intra-articular Fracture of Humeral Trochlea: Surgical Management by Posterior Approach

Vol 42 | Issue 1 | January-June 2021 | page: 28-30 | Akshay Mylarappa, Sanket Mishra


Authors: Akshay Mylarappa [1], Sanket Mishra [1]

[1] Department of Orthopaedics, IMS & SUM Hospital, Bhubaneswar, Odisha, India.

Address of Correspondence

Dr. Akshay Mylarappa,
IMS & SUM Hospital, Bhubaneswar, Odisha, India.
E-mail: akshaymylar@gmail.com


Abstract

Isolated fracture of the trochlea is rare and is only recorded approximately 15 times in literature and the surgical management by posterior approach is never described. The rare incidence may be attributed to its position deep inside the elbow joint without any tendinous or ligamentous attachment, thus protected from any injury. We report a rare case of fracture of the trochlea and its surgical management by posterior approach with Chevron’s olecranon osteotomy and also describe the advantages and disadvantages of the approach. Functional outcome at two-year follow-up was satisfactory.

Keywords: Isolated humeral trochlea; Intra-articular fracture; Posterior approach.


References

1. Hotchkiss RN, Green DP. Fractures and Dislocations of the Elbow. In: Rockwood CA, Green DP, Bucholz RW, editors. Rockwood and Green’s Fractures in Adults. 3. Philadelphia: Lippincott; 1991. pp. 739–841
2. Singh AP, Dhammi IK, Jain AK, Jain S. Neglected isolated fracture of the trochlea humeri. Chin J Traumatol. 2010;13(4):247-249.
3. Kaushal R, Bhanot A, Gupta PN, Bahadur R (2005) Isolated shear fracture of humeral trochlea. Inj Extra 36:210–211. https://doi.org/10.1016/j.injury.2004.09.041
4. Abbassi N, Abdeljaouad N, Daoudi A, Yacoubi H (2015) Isolated fracture of the humeral trochlea: a case report and review of the literature. J Med Case Reports 9:. https://doi.org/10.1186/s13256-015-0564-1
5. Nauth A, McKee MD, Ristevski B, et al (2011) Distal humeral fractures in adults. J Bone Joint Surg Am 93:686–700. https://doi.org/10.2106/JBJS.J.00845
6. Chamseddine A, Hamdan H, Obeid B, Zein H (2009) [Articular coronal fractures of the distal humerus]. Chir Main 28:352–362. https://doi.org/10.1016/j.main.2009.08.009
7. Nakatani T, Sawamura S, Imaizumi Y, et al (2005) Isolated fracture of the trochlea: a case report. J Shoulder Elbow Surg 14:340–343. https://doi.org/10.1016/j.jse.2004.07.012
8. Singh R, Singh H, Kanodia N (2019) Olecranon Osteotomy Approach for Complex AO-13C Fractures of Distal Humerus: A Prospective Analysis of 24 Cases. Malays Orthop J 13:30–35. https://doi.org/10.5704/MOJ.1903.005
9. Shahane SA, Stanley D (1999) A posterior approach to the elbow joint. J Bone Joint Surg Br 81:1020–1022. https://doi.org/10.1302/0301-620x.81b6.9696

How to Cite this Article: Mylarappa A, Mishra S | A Rare Case of Isolated Intra-articular Fracture of Humeral Trochlea: Surgical Management by Posterior Approach | Odisha Journal of Orthopaedics & Trauma | January-June 2021; 42(1): 28-30.

(Abstract) (Full Text HTML)      (Download PDF)


 

 

 

 

 

 

 

 

 

 

 

 

 

Solitary Plasmacytoma of Medial End of Clavicle: A Rare Case Report

Vol 42 | Issue 1 | January-June 2021 | page: 21-23 | Avinash Naik, Saurav N. Nanda, Sourav Kumar Pal, K Srikant, Debashish Mishra


Authors: Avinash Naik [1], Saurav N. Nanda [1], Sourav Kumar Pal [1], K Srikant [1], Debashish Mishra [1]

[1] Department of Orthopaedics, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India.

Address of Correspondence

Dr. Avinash Naik,
Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India.
E-mail: dravinashnaik@gmail.com


Abstract

Introduction: Clavicle, an unusual site for an expansile lytic lesion of bone with multiple differential diagnostic possibilities and plasmacytoma being one of them, although reported but very rare. Solitary plasmacytoma of bone(SBP) are a localized bone tumour consisting of plasma cells with no other clinical features that of multiple myeloma. We are presenting such a rare case of solitary plasmacytoma of bone involving the medial end of the clavicle.
Case report: A 40-year female presented with complaints of pain and swelling in the inner aspect of the left clavicle since 2 months. Radiographs showed a lytic expansile lesion involving the medial end of the clavicle and confirmed with CT scan. FNAC was inconclusive and hence excisional biopsy done with a provisional diagnosis of giant cell tumour (GCT). Histopathology features suggestive of plasma cell neoplasm like nodules of plasma cells with an enlarged nucleus and also IHC quantified plasma cells with stains for kappa and lambda. Skeletal survey, serum and urinary electrophoresis, alkaline phosphatase, haemoglobin, renal function test, ESR, CRP, serum calcium and phosphate levels were within normal limits. Bone marrow biopsy also ruled out the possibility of multiple myeloma hence a possible diagnosis of solitary plasmacytosis of bone was made. The patient was further evaluated by oncologists and subsequently, radiotherapy was given. The patient has been in regular follow up for 2 years with no signs of recurrence and multiple myeloma.
Conclusion: Clavicle, although an unusual site of primary bone tumour, should be kept in mind for any swelling around it. Plasmacytoma should also be considered as a differential along with other commoner differentials like GCT, fibrous dysplasia for osteolytic expansile lesions in the clavicle. Multiple myeloma should be ruled at presentation and at long term regular follow-ups to be considered as solitary plasmacytoma of bone after histopathological diagnosis.
Keywords: Plasmacytoma; Clavicle.


References

1. Dr. Chinmay Biswas, Dr. Chinmay Biswas, Dr. Abhradip Mukherjee, Dr. Soumen Roy, 2016. “Solitary Plasmacytoma of clavicle: A rare case report”, International Journal of Current Research, 8, (01), 25387-25389.
2. Jaffe ES, Harris NL, Stein H, Vardiman JW (2001) World Health Organization Classification of Tumours: Pathology and Genetics, Tumours of Haematopoietic and Lymphoid Tissues. Ann Oncol 13: 490-491.
3. Panagopoulas A,Megas P,Kaisidis A,Dimakopoulos P(2006)Radiotherapy Resistant Solitary Bone Plasmacytoma of clavicle.European journal of Trauma 32:190-193.
4. Nirmalesh M & Indranil C & Palash K M & Bidyut K G.(2018).Cytohistopathological Diagnosis of Solitary Plasmacytoma of Clavicle: A Rare Site for a Rare Tumor. Biomed Journal of Scientific & Technical Research. 2. 10.26717/BJSTR.2018.02.000660.
5. Kleins, Kuppers R (1999) The New England Journal of Medicine. 341: 1520.
6. Shahid M,Hali NZ,Mubeen A,Zaheer S,Julfiqar(2010)Solitary Plasmacytoma of Clavicle-A rare case presentation.J Cytol Histol 1:103.doi:10.4172/2157-7099.1000103.
7. Dimopoulos, M.A., Moulopoulos, L.A., Maniatis, A., et al. 2000. Solitary plasmacytoma of bone and asymptomatic multiple myeloma. Blood, 96:20372044

How to Cite this Article: Naik A, Nanda SN, Pal SK, Srikant K, Mishra D| Solitary Plasmacytoma of Medial End of Clavicle: A Rare Case Report | Odisha Journal of Orthopaedics & Trauma | January-June 2021; 42(1): 21-23.

(Abstract) (Full Text HTML)      (Download PDF)