Acute Compartment Syndrome is a limb-threatening emergency and it occurs most commonly after fractures. The aim of our study is to find out the effectiveness of serial measurement of differential pressure in closed tibial diaphyseal fractures, in diagnosing acute compartment syndrome, using Whiteside’s technique. A total of 52 cases in the age group of 15 to 55 years admitted with closed fractures were studied for serial compartment pressure as well as serial differential pressure. Eight patients had persistent compartment pressure > 40mmHg, out of which only two patients had persistent differential pressure < 30mmHg and these two patients underwent fasciotomy. Thus, by measuring the compartment pressure serially and calculating differential pressure serially, acute compartment syndrome can be diagnosed or ruled out with higher precision, so that unnecessary fasciotomies can be avoided.
Introduction:The posterior inclination of the tibial plateau relative to the longitudinal axis of tibia is referred to as the posterior tibial slope (PTS). There is paucity of data regarding PTS in Indian population. Metaphysio-diaphyseal angle (MDA) is the angle between longitudinal axis of tibia and proximal tibial metaphysis, a new entity with a possible clinical significance. This study was performed to determine the mean PTS and mean MDA to study the correlation of PTS and MDA changes with osteoarthritic degeneration in Indian population and to assess the sensitivity and specificity of PTS and MDA in detecting osteoarthritis. A descriptive, cross-sectional study design was followed. Materials and methods: A total of 173 X-rays with true PA and lateral views were examined from 121 individuals using standardized technique. Osteoarthritis was classified based on Ahlback grading system. Posterior tibial slope was defined as the angle formed by two lines in the lateral knee radiograph. Metaphysio-diaphyseal angle is a new entity defined in this study, formed between two lines-first line is the proximal anatomical axis of the tibia and the second is the axis of the proximal tibial metaphysis. All the observations and measurements of PTS and MDA were statistically analyzed using MedCalc software. Results: There were 121 individuals in the study with 91 osteoarthritic knees and 82 normal knees. The mean PTS among normal group is 9.69° [range 5-13° with standard deviation (SD) 1.81] and among arthritic group is 14.05° (range 10-24° with SD 2.38). The mean MDA among normal group is 19.87° (range 15-30° with SD 2.70) and among arthritic group is 25.03° (range 19-34° with SD 3.05). There is a moderate correlation between PTS and MDA (r = 0.64). Sensitivity and specificity in detecting osteoarthritis with PTS is 96.7% and 85.4% and by MDA is 90.1% and 84.7%, respectively. Conclusion:Our study finds that native PTS is similar to that of oriental population but higher than that of Caucasians. There is moderate linear correlation between PTS and MDA. They also serve as a marker in detecting osteoarthritis with good sensitivity and specificity.
Introduction: Since acetabular fractures are intra-articular, accurate anatomic reduction is essential to achieve a good functional outcome. Among the various surgical approaches, ilioinguinal and modified Stoppa approaches are the only available intra-pelvic approaches. Even though ilioinguinal approach is more commonly used, modified Stoppa approach is becoming more popular due to the possibility of visualising and reducing quadrilateral plate fragments as well as fixation of posterior column through anterior approach. The aim of our study was to assess the efficacy of various reduction tools/ techniques for reduction and fixation of fractures operated using modified Stoppa approach. Materials and Methods: We have operated on 16 patients with acetabular fractures through modified Stoppa approach in the age group of 19 years to 70 years (mean 42 years) with male female ratio of 13:3. In patients requiring combined approach, the anterior approach was done first. In all the patients, modified Stoppa was combined with a lateral window. We have used various reduction techniques including transtrochanteric Schanz pin, intra-focal elevators, ball spike, bone hook, iliac crest Schanz pin, Farabeuf forceps, undercontoured plate, etc. Results: Matta's radiographic reduction criteria showed anatomic reduction in 10 cases. Clinical assessment using Merle d' Aubigne scoring showed excellent results in 9 cases and good results in 6 cases. Follow up was done for a maximum period of six months. Conclusion: Modified Stoppa approach provides better visualisation of quadrilateral surface and sciatic buttress when compared to the ilioinguinal approach. The use of appropriate reduction techniques helps in achieving good reduction of anterior column, at the same time provides opportunity to fix the posterior column from the anterior aspect using anterior to posterior column screws, obviating the need for a separate posterior approach.
Introduction: Among various spine disorders, degenerative conditions like lumbar disc disease and spondylolisthesis are commonly encountered. Surgery is the option if conservative management fails. Fusion is the only option to alleviate instability. Transforaminal Lumbar Interbody Fusion (TLIF) is a promising procedure to achieve this goal. The aim of our study was to evaluate whether unilateral TLIF with one cage is comparable with other established techniques. Materials and Methods: This is a prospective study with 11 males & 11 females who have undergone TLIF for disc disease and low grade listhesis. A single TLIF cage was used for single level pathologies. In one patient with contiguous two level disc disease, two level TLIF was performed. Results: Results were analysed with respect to intra-op parameters (like surgery duration, blood loss, etc.) and post-op parameters (like fusion, pain relief, etc.). Oswestry Disability Index was used to measure functional outcome. There was a statistically significant improvement in post-op scores (p<0.0001). One complication in the form of Ischemic Optic Neuropathy was encountered. Conclusion: Proper patient selection and surgeon's expertise are important for a successful outcome. TLIF has many advantages when compared to other fusion techniques. It is an ideal management for treating degenerative disc disease and listhesis of low grades.
Background Congenital radial head dislocation by far is a rare condition and also the most common congenital anomaly of elbow. It causes symptoms such as joint stiffness, snapping, locking, or pain; however the diagnosis is sometimes made incidentally from X-rays. Surgical management includes osteotomy of radius, osteotomy of ulna, or radial head excision. Aim and objective The treatment goal is to ameliorate the symptoms and obtain a joint with a full range of motion. Case description Only unilateral cases have been described in literature until now. This article presents a case of bilateral congenital radial head dislocation in a pediatric girl with progressing valgus deformity, treated surgically by a newer technique. We successfully performed an ulnar osteotomy and distraction osteogenesis of ulna with an UMEX external fixator. Once the radial head was brought to the level of the joint, open reduction was done. Conclusion The clinical and functional outcomes were satisfactory. Clinical significance Even though various surgical options are available for the management of congenital radial head dislocation, radial head preserving surgery will benefit the patient on the long run by avoiding the development of distal radioulnar joint problems. Our procedure helps in achieving this goal. How to cite this article Ramprasath DR, Esthak AJM. A Rare Case of Bilateral Congenital Radial Head Dislocation: A Case Report. J Orth Joint Surg 2020;2(2):66–69.
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