Background:Nonunion of patella is an uncommon entity prevalent more commonly in developing countries. Many of them have a functional knee joint and only those with a wide gap and failed extensor mechanism need surgery. We report an analysis of nonunion of fracture patella treated by 3 surgical method.Materials and Methods:35 patients of nonunion/delayed union of patella with significant gap and failure of quadriceps mechanism, underwent three different methods surgically: 1) V–Y plasty and tension band wiring (n=10); 2) patellar traction followed by tension band wiring without V–Y plasty (n=15); and 3) patellar traction followed by partial or total patellectomy (n=10). We compared the results of the treatment in terms of Knee Society Score (KSS), Melbourne patella score, time of union, pain, range of movement, quadriceps power, and ability to do daily activities and complications encountered.Results:The 15 cases of patellar traction followed by tension band wiring showed the best results in terms of time to return to normal activities and complications encountered. Cases with patellectomy showed the next best results but they had a longer period of rehabilitation with ultimately lesser patient satisfaction. V–Y plasty gave the worst results both in complication rate and function return.Conclusion:Preoperative patellar traction followed by tension band wiring is a good procedure giving better results than either patellectomy or V–Y plasty.
Pain is believed to be a poorly understood phenomenon, which is mostly regulated by neural, cellular, hormonal & emotional components. Epidural analgesia is used for pain relief in patients undergoing primary total knee arthroplasty, though provides good pain control, many a time is associated with side effects such as hypotension, urinary retention and impaired mobility. The purpose of the current study is to compare the efficacy of ACB to local infiltration of analgesics by Intraarticular Epidural Catheter for primary total knee arthroplasty by comparing visual analog scale, knee flexion, and active SLRT on the day of surgery (POD-0), POD1-3, day of discharge, and 4 weeks after surgery. This study is prospectively randomized, the cases undergoing primary knee replacement were divided into two groups, which includes a minimum of 36 cases in each group.Group-1(36) patients received local infiltration of analgesics via IAECand Group-2(36) patients received single shot ACB. As far as age, sex, BMI(kg/m2), pre-op VAS, mean pre-op flexion, mean pre-operative varus, mean preop KSS(Knee society score), duration of surgery and hospital stay is concerned no significant difference was noticed between the two groups.Group-1(LIA via IAEC) had significantly lower VAS on a postoperative day (POD) 1-3, lower tramadol consumption, better ROM (atPOD1-3), superior quadriceps recovery(active SLRT), earlier mobilization day, better KSS (at 4weeks) postoperatively, compared to Group-2(single shot ACB).LIAby IAEC for patients undergoing primary TKA is a better option compared to single shot ACB concerning to pain levels, narcotic usage, range of motion, quadriceps recovery and KSS (Knee society score).
Stiff elbow is a common problem associated with terrible triad injuries which if not managed properly can lead to significant functional limitations. Here we are describing a case of post-traumatic stiff elbow following terrible triad who presented to us after taking native treatment primarily. He was treated with open arthrolysis and prophylactic ulnar nerve decompression along with rigorous physiotherapy including dynamic splinting with hinge elbow bracing. The results were satisfactory in achieving a functional range of movement according to the patient's vocational need. This study aims to present the prompt management of post-traumatic stiff elbow case along with functional improvement postoperatively in a decisive way. Terrible triad injuries are a group of the rare and severely unstable fracturedislocations following which the chance of recurrent instability, elbow stiffness, and functional limitations increases coherently.1 To perform normal daily activities, painless motion at the elbow joint is very much necessary and critical. Following a traumatic insult, a cascade of events can lead to a decrease in the normal arc of motion and also cause stiffness of the elbow joint.2 Over the last two decades, there has been a lot of speculation revolving around the management of terrible triad injuries.3 Van Riet et al had documented that the majority of the terrible triad injuries need to be managed surgically whereas the non-operative treatment is reserved for a few selected cases. 4 The ones which were not managed adequately had higher chances of turning up into stiff elbow. Post-traumatic elbow stiffness is one of the dreaded complications following terrible triad injuries.3 The aim of managing the case of post-traumatic stiff elbow is to have a painless, near-normal range of motion which can help the patient to do daily activities by himself. We are presenting a case of post-traumatic type- 4 stiff elbow following native bandage treatment and how prompt management has led to satisfactory results.
To assess the effectiveness of the two techniques (MIPPO & IMILN) & Compare outcome. Methods: This is a Prospective, Randomized control trial involving 52 cases of extra-articular proximal tibial fractures treated either with MIPPO or IMILN in the Department of Orthopaedics, IMS and SUM Hospital, Bhubaneswar during September 2017 to September 2019. Functional outcome was calculated with Lower extremity functional scale and Knee society score and final outcome with Johner Wruhs criteria.Results: Each group had 26 cases in them, cases were followed-up for an average duration of 11.9 months. 2 cases from MIPPO group and 4 from IMILN group lost follow up. The average time to radiological union in MIPPO group was 16.1 weeks and that in IMILN group was 16.9 weeks. IMILN group had a higher rate of mal-reduction (19.1%) than MIPPO (15.4%). anterior angulation of the proximal fragment was commonest. Superficial infection occurred in 8.3% cases of MIPPO group and 4.5% in IMILN group. Non-union occurred in 1 (4.2%) and 1 delayed union (4.2%) in MIPPO group. Non-union developed in 1 case in IMILN group (4.5%) and 2 cases of delayed union (9.1%). Implant irritation was seen in 2 of our cases (8.3%) in MIPPO group. Anterior knee pain was observed in 2 patients in IMILN group (9.1%). LEFS in MIPPO was 45.8% and IMILN was 40.9%. Final outcome showed excellent result in 50% and 45.4% in MIPPO and IMILN respectively. Conclusions: If principles of treatment are correctly followed, most of cases will have excellent result with either modality of treatment.
Unstable osteoporotic intertrochanteric fractures are common in the elderly population. Failure rate of as high as 56% have been noted with internal fixation of unstable fractures mainly due to inadequate purchase in the osteoporotic bone and early full weight bearing. Hemiarthroplasty is a frequently employed alternative as it gives stability and allows immediate full weight bearing. This study evaluates the role of primary cemented hemiarthroplasty in the treatment of unstable trochanteric fractures in elderly and physiologically elderly patients. 30 elderly patients who were above 60 years of age with unstable osteoporotic intertrochanteric fractures, who underwent cemented bipolar hemiarthroplasty were studied prospectively from July 2017-july 2019. Patients who were less than 60 years of age, non ambulatory before injury and patients with stable intertrochanteric fractures, pathological fractures cognitive impairment were excluded from the study. Fractures were classified based on Boyd and Griffin classification. All the patients were treated with cemented bipolar prosthesis through posterior (Moore's) approach. Mean follow up period was 12 months. Patients were assessed using modified Harris hip score. This study included 12 males and 18 female patients with mean age of 73. There were 24 patients with a byod and griffin type 2 injury and 6 patients sustained a byod and griffin tye 3 injury. The average intra operative blood loss was 357 ml and average operative time was 75 mins. On an average patients were allowed to bear full weight on 7 th post operative day. 2 patients had superficial infection and 1 patient had a shortening more than 2 cms. 9 patients had abductor weakness. There were no cases of prosthetic dislocation, periprosthetic fracture, acetabular erosion and stem loosening. Primary cemented hemiarthroplasty for unstable osteoporotic elderly trochanteric fractures appears to be a good alternative treatment modality. Early full weight bearing and rehabilitation is a definitive advantage of this method.
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