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   2011| September-October  | Volume 45 | Issue 5  
    Online since August 18, 2011

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Outcome of closed proximal phalangeal fractures of the hand
Jaswinder Singh, Karun Jain, Mruthyunjaya , R Ravishankar
September-October 2011, 45(5):432-438
DOI:10.4103/0019-5413.83764  PMID:21886925
Background: The proximal phalanx (PP) of the fingers is fractured more frequently than the middle or even distal phalanges. The problems of malunion, stiffness and sometimes loss of skin or other soft tissues associated with PP fracture increases the disability. The optimum treatment depends on fracture location, fracture geometry and fracture stability. The objective of the study was to analyse the treatment outcome in a series of closed proximal phalangeal fractures of the hand. Materials and Methods: Eighty-four proximal phalangeal fractures in 68 patients were enrolled from 2007 to 2009. The treatment modalities were broadly categorised into two groups, Group A consisted of conservative treatment, and Group B consisted of surgical treatment. Group A included 47 digits treated with closed reduction (CR) with immobilization (n=43), extension block cast and dynamic traction (n=4), while 37 digits were treated in Group B, which included closed or open reduction (OR) and internal fixation (IF) with K-wires (n=31), OR and IF with stainless-steel wiring (n=2), and mini external-fixator (n=4). Belsky's criteria and Gingrass' criteria were used for assessment of finger injuries and to assess the efficacy of conservative and surgical modalities for closed proximal phalangeal fractures of the hand. Results: Average period of follow-up was 1 year (range 10-14 months). The excellent to good results seen in Groups A and B were 89% and 92%, respectively. Six complications were seen in Group A, which included four cases with malunion and two cases with digital stiffness. Three complications were seen in Group B, which included one each of malunion, digital stiffness and extensor lag. Overall, maximum poor results (n=4) were seen with CR and buddy strapping. Conclusion: Conservative treatment is an inexpensive method, particularly suitable for stable fractures, and in patients who are poor candidates for surgery, Surgical modalities have distinct advantage of stable fixation, but with added risk of digital stiffness. Percutaneous pinning is a reliable, most commonly used surgical modality and technically easier. Both conservative and surgical modalities have good efficacy when used judiciously.
  10,841 221 7
Spinaplasty following lumbar laminectomy for multilevel lumbar spinal stenosis to prevent iatrogenic instability
Surendra Mohan Tuli, Varun Kapoor, Anil K Jain, Saurabh Jain
September-October 2011, 45(5):396-403
DOI:10.4103/0019-5413.83140  PMID:21886919
Background: Iatrogenic instability following laminectomy occurs in patients with degenerative lumbar canal stenosis. Long segment fusions to obviate postoperative instability result in loss of motion of lumbar spine and predisposes to adjacent level degeneration. The best alternative would be an adequate decompressive laminectomy with a nonfusion technique of preserving the posterior ligament complex integrity. We report a retrospective analysis of multilevel lumbar canal stenosis that were operated for posterior decompression and underwent spinaplasty to preserve posterior ligament complex integrity for outcome of decompression and iatrogenic instability. Materials and Methods: 610 patients of degenerative lumbar canal stenosis (n=520) and development spinal canal stenosis (n=90), with a mean age 58 years (33-85 years), underwent multilevel laminectomies and spinaplasty procedure. At followup, changes in the posture while walking, increase in the walking distance, improvement in the dysesthesia in lower limb, the motor power, capability to negotiate stairs and sphincter function were assessed. Forward excursion of vertebrae more than 4 mm in flexion-extension lateral X-ray of the spine as compared to the preoperative movements was considered as the iatrogenic instability. Clinical assessment was done in standing posture regarding active flexion-extension movement, lateral bending and rotations. Results: All patients were followed up from 3 to 10 years. None of the patients had neurological deterioration or pain or catch while movement. Walking distance improved by 5-10 times, with marked relief (70-90%) in neurogenic claudication and preoperative stooping posture, with improvement in sensation and motor power. There was no significant difference in the sagittal alignment as well as anterior translation. Two patients with concomitant scoliosis and one with cauda equine syndrome had incomplete recovery. Two patients who developed disc protrusion, underwent a second operation for a symptomatic disc prolapse. Conclusion: Spinaplasty following posterior decompression for multilevel lumbar canal stenosis is a simple operation, without any serious complications, retaining median structures, maintaining the tension band and the strength with least disturbance of kinematics, mobility, stability and lordosis of the lumbar spine.
  10,764 200 4
Evaluation of the syndesmotic-only fixation for Weber-C ankle fractures with syndesmotic injury
R Mohammed, S Syed, S Metikala, SA Ali
September-October 2011, 45(5):454-458
DOI:10.4103/0019-5413.83953  PMID:21886929
Background: With the length of the fibula restored and the syndesmosis reduced anatomically, internal fixation using a plating device may not be necessary for supra-syndesmotic fibular fractures combined with diastasis of inferior tibio-fibular joint. A retrospective observational study was performed in patients who had this injury pattern treated with syndesmosis-only fixation. Materials and Methods: 12 patients who had Weber type-C injury pattern were treated with syndesmosis only fixation. The treatment plan was followed only if the fibular length could be restored and if the syndesmosis could be anatomically reduced. Through a percutaneous or mini-open reduction and clamp stabilization of the syndesmosis, all but one patient had a single tricortical screw fixation across the syndesmosis. Patients were kept non-weight-bearing for 6 weeks, followed by screw removal at an average of 8 weeks. Outcomes were assessed using an objective ankle scoring system (Olerud and Molander scale) and by radiographic assessment of the ankle mortise. Results: At a mean follow-up of 13 months, the functional outcome score was 75. Excellent to good outcomes were noted in 83% of the patients. Ankle mortise was reduced in all cases, and all but one fibular fracture united without loss of fixation. Six patients had more than one malleolar injury, needing either screw or anchor fixations. One patient had late diastasis after removal of the syndesmotic screw and underwent revision surgery with bone grafting of the fibula. This was probably due to early screw removal, before union of the fibular fracture had occurred. Conclusion: We recommend syndesmosis-only fixation as an effective treatment option for a combination of syndesmosis disruption and Weber type-C lateral malleolar fractures.
  10,260 185 9
Outcome of radial head preserving operations in missed Monteggia fracture in children
Parag Garg, Prashant Baid, Shivam Sinha, Rajeev Ranjan, Utpal Bandyopadhyay, SR Mitra
September-October 2011, 45(5):404-409
DOI:10.4103/0019-5413.83946  PMID:21886920
Background: The dislocated radial head in missed Monteggia fracture loses its concave articular surface and displays hypertrophic changes and flattened humeral capitellum configuration, thereby limiting the range of motion. We evaluated the results of open reduction in missed Monteggia fractures by various techniques. Materials and Methods: Sixty-three missed Monteggia fractures were included in the analysis. We performed four combinations of operation: Group I: 22 patients treated with modified Hirayama ulnar osteotomy plus annular ligament reconstruction with free Palmaris longus grafting; Group II:18 patients treated with modified Hirayama ulnar osteotomy plus annular ligament reconstruction by the Bell Tawse's procedure; Group III-9: patients treated with only modified Hirayama's osteotomy; and Group IV: 14 patients treated with transverse osteotomy of ulna and annular ligament reconstruction by the Bell Tawse's procedure. During followup these cases were assessed for the following parameters: 1) range of motion and 2) mayo elbow performance index (MEPI). Results were noted on follow ups at 3, 6, 12 months and then on yearly basis. Sixty-three patients were followed up for an average duration of 5.6 years (range 3-8 years). Results: The mean range of motion was increased by 45°, 30°, 45°, 20° for Group I, II, III and IV respectively. The average increase in MEPI scores was also almost on the same lines. There was one case of frank dislocation in group III and six cases of subluxation, two each in Groups II, III, and IV. For Annular ligament reconstruction, amongst two procedures, Groups II and IV (Bell Tawse group), had a significant extension lag contributing to the lower increase in the range of motion as compared to the Palmaris longus reconstruction group (group I). Conclusion: Hirayama's osteotomy is inherently more stable than the simple transverse osteotomy and it should be combined with annular ligament reconstruction. Palmaris longus graft for ligament reconstruction provides more stability as compare to Bell Towse's procedure.
  8,048 501 3
Internal fixation of fractures of both bones forearm: Comparison of locked compression and limited contact dynamic compression plate
KC Saikia, SK Bhuyan, TD Bhattacharya, M Borgohain, P Jitesh, F Ahmed
September-October 2011, 45(5):417-421
DOI:10.4103/0019-5413.83762  PMID:21886922
Background: The locking compression plate (LCP) with combination holes is a newer device in fracture fixation. We undertook a study comparing the LCP with limited contact dynamic compression plate (LC-DCP) in the treatment of diaphyseal fractures of both bones of the forearm. Materials and Methods: This is a prospective comparative study, 36 patients (18 in each group) with fractures of both the forearm bones (72 fractures) were treated with one of the two devices. The average age of the patients was 30.5 years (range 16-60 years) with mean followup of 2.1 years (range 1.5-2.8 years). The patients were assessed for fracture union and function and complications and by Disabilities of the Arm, Shoulder and Hand (DASH) score for patient related outcome at the latest followup. Results: There was no significant difference in two groups with respect to the range of movements or grip strength. One case had delayed union (LC-DCP group) and another had synostosis (LCP group). Plate removal was done in four cases within the study period with no refracture till the presentation of this report. Conclusion: LC plating is an effective treatment option for fractures of both bones of forearm. The present study could not prove its superiority over LC-DCP.
  7,659 336 7
Percutaneous pinning for non-comminuted extra-articular fractures of distal radius
Abhishek K Das, Nandkumar Sundaram, Thiruvengita G Prasad, Suresh K Thanhavelu
September-October 2011, 45(5):422-426
DOI:10.4103/0019-5413.83949  PMID:21886923
Background: Various treatment modalities have been described for the treatment of extra-articular distal radius fractures each with its own merits and demerits. Most of the work done with percutaneous pinning has shown a significant residual stiffness of the hand and wrist. Our technique involves percutaneous pinning of the fracture and immobilization in neutral position of the wrist for three weeks. This study's aim was to examine the functional outcome of percutaneous K-wiring of these extra-articular distal radius fractures with immobilization in neutral position of the wrist. Materials and Methods: This is a prospective study of 32 patients aged between 18 and 70 years with extra-articular distal radius fracture. Patients were treated with closed reduction and percutaneous pinning using two or three K-wires. A below- elbow plaster of paris dorsoradial slab was applied in neutral position of the wrist for 3 weeks. At the end of 3 weeks, the slab was removed and wrist physiotherapy started. The radiographs were taken postoperatively, at 3 weeks, 6 weeks and 6 months. The functional evaluation of the patients was done at 6 months follow-up. We used Sarmiento's modification of Lindstrom criteria and Gartland and Werley's criteria for evaluation of results. Results: Excellent to good results were seen in 93.75% of the cases while 6.25% had fair results. The complications observed were pin loosening (n=13), pin tract infection (n=2), malunion (n=2), wrist joint stiffness (n=2), reduced grip strength (n=2) and injury to the superficial radial nerve (n=1). Conclusion: Percutaneous pinning followed by immobilization of the wrist in neutral position is a simple and effective method to maintain reduction and prevent stiffness of wrist and hand.
  6,483 424 8
Computer navigation assisted fixation in neglected C2-C3 dislocation in an adult
S Rajasekaran, M Subbiah, Ajoy Prasad Shetty
September-October 2011, 45(5):465-469
DOI:10.4103/0019-5413.80333  PMID:21886931
A 49-year-old male presented with neck pain and deformity following an industrial accident sustained two months back. His neurology was normal except for a minimal weakness in left biceps (grade 4/5). Radiographs, magnetic resonance imaging and computed tomographic scan revealed fracture dislocation of C2-C3 with significant lateral translation of C2 over C3 without disc herniation. In view of unsuccessful closed reduction and absent disc herniation at the level of dislocation, a posterior only reduction, stabilisation and fusion with Iso-C 3D computer navigation-assisted cervical pedicle screw fixation with transverse rod-screw construct was performed. At 6 months followup the patient was completely relieved of his symptoms and was able to return to his previous occupation. The rare case is reported for the management by Iso-C 3D computer navigation assisted cervical pedicle screw fixation and reduction with transverse rod-screw construct at each involved level.
  5,563 102 -
Management of thromboangiitis obliterans using distraction osteogenesis: A retrospective study
Sunil Kulkarni, GS Kulkarni, Ashok K Shyam, Milind Kulkarni, Ruta Kulkarni, Vidisha Kulkarni
September-October 2011, 45(5):459-464
DOI:10.4103/0019-5413.83954  PMID:21886930
Background: Thromboangiitis obliterans (TAO), also known as Buerger disease, is characterized by thrombosis in medium-sized arteries and veins along with a marked inflammatory response. TAO can be managed by using the principle of distraction osteogenesis to induce neoangiogenesis. We report thirty patients of TAO in the age-group of 20-50 years were treated with the Ilizarov method. Materials and Methods: Patients with severe rest pain (n=30), absent distal pulsation (n=30) and ulcer (n=6) and/or gangrene of the toes (n=4), who had failed the conservative pharmacological modalities of treatment were included. A lateral tibial corticotomy was performed and distraction applied by use of olive wire. A two-ring frame was used for all cases. Results: Of the 30 cases, 25 patients became pain free while 1 had partial relief of pain. The four patients worsened on treatment and developed frank infection were amputed. The average distraction was 1.8±0.3 mm (range: 1.5-2.2 cm). The mean consolidation period was 98±11 days, after which the fixator was removed. The total duration of treatment was 122±23 days. There were two cases of osteomyelitis in our series; both healed after debridement and both patients had good result, with relief of pain. The ulcers started healing by 4-6 weeks. Conclusion: The principle of the distraction osteogenesis including neoangiogenesis can be used for treatment of TAO and has an acceptable complication rate.
  5,117 153 2
Intramedullary fixation of forearm fractures with new locked nail
Himanshu Bansal
September-October 2011, 45(5):410-416
DOI:10.4103/0019-5413.83760  PMID:21886921
Background: Lack of availability of interlocked nails made plate osteosynthesis the first choice of treatment of forearm fractures inspite of more surgical exposure, periosteal stripping and big skin incision subsequent scar along with higher risk of refracture on implant removal. We hereby report the first 12 cases with 19 forearm bone fractures internally fixed by indegenous interlocked nail. Materials and Methods: Existing square nails were modified to have a broad proximal end of 5.5 mm with a hole for locking screw of 2.5 mm. The nail has a distal hole of 1/1.2/1.5 mm in 2.5/3/3.5 mm diameter nail, respectively. A new method of distal locking with a clip made of k wire is designed. The clip after insertion into the bone and hole in nail and opposite cortex snuggly fits the bone providing a secure locking system. Twelve skeletally mature patients, mean age 32 years (range 24-45 years) with 19 diaphyseal fractures of the forearm were treated with this indigenously made new nail. The patient were evaluated for fracture union, functional recovery and complications. The functional outcome was assessed by disabilities of arm, shoulder and hand questionnaire (DASH score). Results: Time to radiographic union ranged between 12 and 28 weeks, with a 100% union rate. Complications were minimal, with mild infection in open fracture (n=1) and delayed union (n=1) in patient with comminuted fracture of the ulna only. The clinical results were excellent. The DASH score ranged between 0 and 36 points. Conclusion: This new interlocking nail may be considered as an alternative to plate osteosynthesis for fractures of the forearm in adults. The advantages are benefit of closed reduction, smaller residual scar, reduced cost and early union with allowance of immediate movements.
  4,293 329 4
Medium term results of Avon patellofemoral joint replacement
Praveen K Sarda, Anup Shetty, Shanmuga S Maheswaran
September-October 2011, 45(5):439-444
DOI:10.4103/0019-5413.83761  PMID:21886926
Background: Ten to fifteen percent of knee arthritis is reported to be isolated patellofemoral arthritis. Total knee arthroplasty is not recommended for isolated patella femoral arthritis particularly in young patients. We present the retrospective review of 45 consecutive patellofemoral replacements performed in 41 such patients, between June 2002 and January 2007. Materials and Methods: All patients were operated by single surgeon (SM) or under his supervision. All forty five patients had minimum three year followup and had the data collected prospectively. No patient was lost to followup. This data was later collated by review of notes, radiographs, and a clinical followup. The patients were assessed using knee function score and Melbourne patellofemoral score. Results: The average followup was 4.5 years. The preoperative average Melbourne (Bartlett) score was 10 (range 5-21). Preoperative knee functional score averaged 57 (range 23-95). The average range of movement was 116° (range 100°-140°). Postoperatively, the average Melbourne knee score improved to 25 (range 11-30), while the knee function score was 85 (range 28 - 100). The difference was statistically significant (P<0.05). Eighty-five percent rated the result as good or excellent, while 12% rated it as fair. Five percent thought the result was poor. The most common complaint was clicking at 40° of flexion (n=7). Six patients underwent arthroscopic lateral release, which improved the symptoms in four patients. Two knees were revised one due to progression of tibiofemoral arthritis and the other due to persistent clicking, yielding a survival rate of 95.6% at an average five year followup. Conclusion: The Avon patellofemoral joint replacement provides predictably good results and excellent survivorship in the medium term, for isolated patellofemoral arthritis. However, progression of tibiofemoral arthritis remains unpredictable and therefore patient selection is crucial to ensure success. Clicking remains a potential problem and can compromise the postoperative results in upto 15% of the cases.
  4,236 90 6
Functional outcome of neglected perilunate dislocations treated with open reduction and internal fixation
Mandeep S Dhillon, Sharad Prabhakar, Kamal Bali, Devendra Chouhan, Vishal Kumar
September-October 2011, 45(5):427-431
DOI:10.4103/0019-5413.83138  PMID:21886924
Introduction: Management of neglected perilunate dislocations is controversial. The various procedures such as open reduction and internal fixation (ORIF), proximal row carpectomy, lunate excision, and wrist arthrodesis have been advocated. The aim of our study was to evaluate the functional outcome of neglected perilunate dislocations managed by ORIF. Materials and Methods: Over a period of 10 years (1996 to 2006), 14 patients with neglected perilunate dislocations (undiagnosed or untreated for 6 weeks or more) were managed by ORIF. Six patients had dorsal trans-scaphoid perilunate dislocation, 6 patients had volar lunate dislocation while the remaining two had a dorsal perilunate dislocation The results were evaluated by clinical scoring system of Cooney et al. Results: The average followup was 4.1 years (range 2-12 years). All except one of the patients operated earlier than 5 months had good results. Of the four patients operated after 5 months, two had a fair result while two had a poor outcome. Chondral damage to the capitate was noted intraoperatively in both the cases with poor outcomes. The two patients were found to have avascular necrosis (AVN) of the lunate; however, functional outcome was fair in both, and both were able to return to their profession. Conclusion: We observed favorable functional results of ORIF in neglected perilunate dislocations up to 5 months after injury. The development of AVN or midcarpal arthritis was not a major disabling factor as long as stability of wrist has been restored. Beyond 5 months, an alternative surgical procedure such as proximal row carpectomy should be contemplated as results of ORIF have not been good uniformly.
  3,687 187 2
Aperture in coronoid-olecranon septum: A radiological evaluation
Necat Koyun, Atif Aydinlioglu, Fatma Nur Gumrukcuoglu
September-October 2011, 45(5):392-395
DOI:10.4103/0019-5413.83945  PMID:21886918
Background: The humerus bone with coronoid-olecranon septal aperture have very narrow medullary canal and extreme anterolateral bowing proximally and/or extreme anterolateral compressed surface at distal part. Septal perforation might make nailing through a retrograde technique more difficult or possibly with an increased risk of iatrogenic fracture at the site of insertion. Coronoid-olecranon perforation might be very important in preoperative planning for successful nailing. Since the data available has been obtained from the ancient studies using the skeletal material, the present study is aimed at investigating originally the presence of the coronoid-olecranon septum perforation in the living subjects, using a radiographic method. Materials and Methods: The study was performed on direct radiograms and computed tomography of the elbow obtained from the 709 volunteers (367 males, 342 females). Results: The incidence of the perforation was found to be 8.6 %. Bilateral occurrence was found to be more common significantly. The highest incidence occurred in second decade. Conclusion: The present study suggests female prepronounced and left asymmetry in case of septal perforation. Bilateral occurrence from our study might be peculiar to the clinician.
  3,314 148 4
Deep vein thrombosis and thromboprophylaxis in arthroscopic anterior cruciate ligament reconstruction
Raviraj Adala, Ashish Anand, Gautam Kodikal
September-October 2011, 45(5):450-453
DOI:10.4103/0019-5413.83952  PMID:21886928
Background: There is no clear evidence in the literature regarding the incidence of deep vein thrombosis (DVT) in patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction. Literature also lacks on the recommendations on thromboprophylaxis in patients undergoing elective arthroscopic ACL reconstruction. We conducted a prospective analysis to assess incidence of DVT in patients undergoing arthroscopic ACL reconstruction. Materials and Methods: 120 consecutive patients with MRI proven ACL injury who were operated for arthroscopic ACL reconstruction were enrolled in this prospective study. None of the patients had risk factors (on history) for DVT, and all were below the age of 45 years. All cases were operated upon by a single surgeon and a standard rehabilitation regime was followed. The patients underwent clinical examination and screening (Doppler ultrasonography/venous scan) for any DVT, on the day prior to surgery, day of discharge (Day 3) and at 4 weeks postsurgery. None of the patients received any form of thromboprophylaxis against DVT. Results: One hundred and twelve patients (61 males and 51 females) completed the study. The average age was 31.6 years (range 24-42 years). All patients underwent arthroscopic assisted ACL reconstruction surgery within 3 weeks of the injury. Two patients (males) in the series had Doppler venous scan proven DVT. One patient was asymptomatic but the screening Doppler picked up the DVT on the third postoperative day. The other patient was symptomatic at 12 weeks with pain and swelling in the leg and had ultrasound -proven DVT. Conclusion: In our study the incidence of deep vein thrombosis in patients undergoing arthroscopic ACL reconstruction is 1.78%. We do not recommend routine thromboprophylaxis in patients, who are not high risk candidates for thrombosis and are of less than 45 years, in patients undergoing arthroscopic ACL reconstruction, with early postoperative rehabilitation.
  3,211 133 13
Forearm gangrene following distraction injury at elbow in a neonate
Biswajit Sahu, Ranajit Panigrahi
September-October 2011, 45(5):479-480
DOI:10.4103/0019-5413.83136  PMID:21886935
Gangrene of limbs in newborn is extremely rare. A number of aetiological factors may account for such type of situation. We describe herewith a case of gangrene of forearm in newborn following distraction injury to the physis of elbow and vessels of forearm by excessive pull on upper limb during difficult delivery.
  3,088 74 1
Atlantoaxial arthrodesis using C1-C2 transarticular screw fixation in a case of Morquio syndrome
Arvind G Kulkarni, Siddharth M Shah
September-October 2011, 45(5):470-472
DOI:10.4103/0019-5413.83766  PMID:21886932
Prophylactic or therapeutic arthrodesis is recommended for atlantoaxial instability in Morquio syndrome. Occipitocervical fusion, the common approach for upper cervical fusion in Morquio syndrome sacrifices the movements at the occipitoatlantal joints. The use of C1-C2 transarticular screws for achieving C1-C2 arthrodesis, without compromising mobility at the occipitoatlantal joint in Morquio syndrome has not been reported. We report a case of Morquio syndrome with atlantoaxial instability and odontoid hypoplasia, where we successfully achieved C1-C2 arthrodesis using transarticular screws and bone graft. The advantages of this method over other methods of atlantoaxial arthrodesis in Morquio syndrome have also been discussed.
  2,995 101 1
Giant cell tumor of the metacarpal bones
Kabul C Saikia, Sanjeev K Bhuyan, Firoz Ahmed, Debashish Chanda
September-October 2011, 45(5):475-478
DOI:10.4103/0019-5413.83957  PMID:21886934
Giant cell tumor (GCT) of hand bones is rare. We present two cases of GCT of metacarpal bone. One case was treated successfully with ray amputation. The second patient underwent wide resection and tricortical iliac crest bone grafting. Till the last follow-up (at 26 and 70 months respectively) both patients have been recurrence free and have returned to their previous occupational activities.
  2,802 176 5
Art and science of Orthopedics
Surendra Mohan Tuli
September-October 2011, 45(5):385-388
DOI:10.4103/0019-5413.83944  PMID:21886916
  2,698 194 1
Midterm results of biologic fixation or mosaicplasty and drilling in osteochondritis dissecans
Tuluhan Yunus Emre, Hakan Cift, Bahadir Seyhan, Erman Ceyhan, Macit Uzun
September-October 2011, 45(5):445-449
DOI:10.4103/0019-5413.83137  PMID:21886927
Background: Osteochondritis dissecans (OCD) primarily affects subchondral bone. Multiple drilling, fixation implant or autogenous osteochondral grafts are reported as treatment options. We present the midterm results of cases in which an OCD lesion was treated by osteochondral autograft transfer and drilling. Materials and Methods: Between 2002 and 2006, 14 knees with International Cartilage Repair Society (ICRS-OCD) type II and III lesions were treated in our clinic using osteochondral autograft transfer and drilling by arthroscopic or open surgery. The average age of our patients was 22.14 years (range 17-29 years) and average followup was of 24.3 months (range 11-40 months). Lesion type was ICRS type II in five patients (35.7%) and ICRS type III in nine patients (64.3%). In cases with ICRS-OCD type II lesions, in situ fixation was applied following circumferential multiple drilling, while mosaicplasty was done following debridement and multiple drilling in cases with ICRS-OCD type III lesion. Mosaicplasty was performed in the lesion area by an average of 2.5 (range 1-3) cylindrical osteochondral autografts. Patients were not allowed to perform loading activities for 3 weeks in the postoperative period; movement was initiated by using CPM device in the early phase; full range of motion was achieved in third week, and full weight bearing was permitted in 6 to 8 weeks. Results: While 6 and 8 patients were classified preoperatively as fair and poor, respectively, according to Hughston scale, excellent and good results were obtained postoperatively in 10 and 4 patients, respectively. During the followup, no problems were detected in any of the patients in the regions where osteochondral graft was harvested. Conclusion: Biologic fixation or mosaicplasty and drilling as a technique to treatment of the lesion in OCD by osteochondral autograft transfer has resulted in good and excellent clinical outcomes in our patients and it is considered that providing blood flow to subchondral bone by circumferencial drilling leads to an increase in the robustness of biological internal fixation and shortens the duration of recovery.
  2,664 87 -
The 3-min appraisal of a diagnostic test
Teresa Chien, Rajesh Malhotra, Mohit Bhandari
September-October 2011, 45(5):389-391
DOI:10.4103/0019-5413.80317  PMID:21886917
  2,592 135 -
Radial nerve entrapement in osseous tunnel without clinical symptoms
Purnima Patni, Narender Saini, Vinit Arora, Shekhar Shekhawat
September-October 2011, 45(5):473-474
DOI:10.4103/0019-5413.83139  PMID:21886933
Entrapment of a nerve in the callus of a healing fracture is not a common entity, but it does exist. The entrapment usually presents without neurological deficit. It is difficult to suspect the radial nerve injury if we need to operate on the same site. We present a case of entrapment of radial nerve in the callus of a supracondylar humerus fracture with cubitus varus deformity. The surgery for correction of the deformity led to the damage of the nerve. In retrospect a careful assessment of the x-rays showed two 3-4 mm diameter holes. Awareness of this finding would have given us sufficient indication of nerve entrapment to prevent this mishap.
  1,931 95 3
Comment on "Tranexamic acid for control of blood loss in bilateral total knee replacement in a single stage"
Raju Vaishya, Vikrant Landge, Anurag Aggrawal, Ankur Chaudhary
September-October 2011, 45(5):483-484
DOI:10.4103/0019-5413.83958  PMID:21886938
  1,657 114 1
Dr. Ambrose James Selvapandian
George A Anderson
September-October 2011, 45(5):485-487
  1,561 92 -
Authors' reply
Mandeep S Dhillon, Kamal Bali, Prabhakar Sharad
September-October 2011, 45(5):484-484
  1,008 59 -
Authors' reply
Nicole Simunovic, PJ Devereaux, Mohit Bhandari
September-October 2011, 45(5):482-482
  968 40 -
The separate or combined evaluation of co-morbidities have a different effect on the role of surgical delay on 1 year mortality
Andor Sebestyén, Imre Boncz
September-October 2011, 45(5):481-482
DOI:10.4103/0019-5413.83767  PMID:21886936
  688 31 2
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