Background: Adequate reconstruction of the soft tissue defect following resection of bone tumors is challenging. Prolene mesh, despite being a useful tool, is not widely used due to the fear of deep infection. The aim of this study was to evaluate the functional outcome and complications of using a Prolene mesh in oncological reconstructions. Methods: A retrospective study was conducted in bone tumor patients with soft tissue reconstruction using Prolene mesh between January 2017 and June 2019. Functional evaluation was done using MSTS 93 score. Complications were recorded and were classified as mechanical (dislocation and extension lag) or biological failure (wound problems and deep infection). Comparison was performed between groups with and without biological failure to identify predictive variables. Results: Of 116 patients, 68 were males and 48 were females, with median age of 22.5 years. Thirty nine patients had tumors of proximal tibia, 23 of proximal femur, 25 of proximal humerus, 24 of pelvis, and five tumors at other sites. Approximately two-thirds (62.9%) of our patients underwent endoprosthetic reconstruction while the rest underwent either biological or cement spacer reconstructions. Excellent or good functional outcomes were reported in 98.3% patients as per MSTS 93 scoring. Complications were noted in 22 patients (18.9%), of which 16 had biological failure, with four patients requiring debridement and mesh removal. Dislocation of prosthesis occurred in 2 patients of proximal femur replacement. Overall re-surgery rate was 5.1% (6 patients). There was no statistically significant difference between the groups with or without biological failure with respect to demographics, site of tumor, type of procedure, blood loss, duration of surgery and history of chemotherapy. Conclusion: Prolene mesh is a useful tool to reconstruct the soft tissue defects following bone tumor resections. It is readily available, reliable and provides reproducible results, with no added risk of wound complications.
Introduction: With a less than ideal health infrastructure and a vast underprivileged population in our country, many cases of Sprengel’s deformity are initially missed and are subsequently untreated. Although for best surgical results, the patient must be under the age of five, many patients present late at out tertiary care center. Thus, we evaluated the clinical results of the modified Woodward’s Procedure in such neglected cases. Methods: A retrospective study, of 16 patients aged 8-yr or above, with Sprengel’s deformity who underwent the modified Woodward’s procedure between 2006 and 2011. Clavicular osteotomy/morselization was avoided. The Cavendish scoring system was used to grade cosmesis and shoulder abduction was used to assess the functional outcome. The patients were prospectively followed up at two-years and after skeletal maturity. Results: There were ten females and six males and the average age was 9.4 years. The mean follow up was 4.2 yr. Omo- vertebral bar excision was done in 13 (81.25%) patients. The mean increase in postoperative shoulder abduction and Cavendish grades at a 2-yr follow-up were, 19.1° and 1.32 grades, respectively. None of our patients needed Clavicular osteotomy/morselisation and none developed neurological abnormalities. The was no change in the values at skeletal maturity. Conclusion: Satisfactory outcomes can be acquired by the Modified Woodward’s procedure in neglected Sprengel’s deformities. Besides a definitive cosmetic correction, the procedure also results in improvement of shoulder abduction. Clavicular Ostetomy/Morselization is not always required in cases presenting after the age of 8 years. Keywords: Woodward’s procedure; Sprengel’s shoulder, Cavendish grading, modified Woodward’s procedure; neglected Sprengel deformity.
<p class="abstract"><strong>Background:</strong> Tibia being a superficial bone of the body and vulnerable to trauma, often becomes fractured among all long bone fractures. Tibial surface is subcutaneous most of its length so open fractures are common.</p><p class="abstract"><strong>Methods: </strong>The present cross sectional study was conducted on 20 patients attending the outpatient department Of Orthopedics, Government Medical College and Hospital, Ambikapur, Sarguja (C.G) India between September 2020 to February 2021. Patients within the age group of 18-60 years, having fracture of any duration with gap non union and those having duration of fracture more than 36 weeks without bony gap were included in the study. Details of Patient’s characteristics concerning primary injury and treatment were recorded and evaluation of results were based on Paleys criteria.</p><p class="abstract"><strong>Results: </strong>In bone/radiological results, seven were classed as excellent, eleven as good with the remainder of 2 being fair and poor each. Functionally nine were graded as excellent, nine as good and two as fair and poor each.</p><p class="abstract"><strong>Conclusions:</strong> It was found that Ilizarov ring fixator is an excellent treatment modality for tibial non-union with infection. However the technique requires long treatment follow up. Multiple interventions may be necessary to overcome the difficulties which come across the treatment.</p>
<p class="abstract">Osteonecrosis, also referred to as avascular necrosis (AVN), aseptic necrosis and ischemic necrosis, is not a specific disease but rather a condition in which a circumscribed area of bone becomes necrotic as a result of a loss of its blood supply. The femoral head is the site most often affected and its frequent cause is a displaced fracture through the femoral neck. This is a case-series study that has been done on 9 patients (10 hips) with clinical and radiological evidence of osteonecrosis of head of femur. After treatment patients were followed clinically and radiographically at 1 to 3 months intervals during first year after the operation and at 3 to 6 months intervals thereafter. Out of 9 study subjects, 7 (77.7%) were male and 2 (22.2%) were female. Mean age was 40±7.5. Among 7 (70%) hips, canulated cancellous screws were used and dynamic hip screw were used in 3 (30%) hips. Majority of the cases, 4 (40%) had more than 2 mm of progressive collapse of transported intact area in their latest follow up. Transtrochanteric rotational osteotomy procedure is valuable and needs to be tried by new genre of orthopedician as it helps in clinical improvement of patient and might also delay the necessity for total hip arthroplasty.</p>
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