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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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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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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


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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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