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   2018| July-August  | Volume 52 | Issue 4  
    Online since July 6, 2018

 
 
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ORIGINAL ARTICLES
Management of neglected lateral condyle fracture of humerus: A comparison between two modalities of fixation
Rahul Ranjan, Abhinav Sinha, Naiyer Asif, Syed Ifthekar, Ashish Kumar, Suresh Chand
July-August 2018, 52(4):423-429
DOI:10.4103/ortho.IJOrtho_319_16  PMID:30078903
Background: Implant for fixation of neglected fracture lateral condyle humerus remains an issue of controversy. This study compares the clinical and radiological outcome of fixation with Kirschner wire (K-wire) and with cancellous screw (CS) in neglected fracture lateral condyle humerus. Materials and Methods: 42 patients of neglected lateral condyle humerus fracture, treated either by open reduction and internal fixation (ORIF) with K-wire or ORIF with CS were included in study. The comparisons were made in term of slab immobilization time, union time, improved range of motion (ROM), final achieved carrying angle, and functional outcome measured by Liverpool Elbow Score (LES). Results: There were 22 patients in Group I with mean age 7.8 years and 20 patients in Group II with mean age 7.3 years. Mean delay in presentation was 12.9 versus 15.6 weeks (P > 0.05). Mean followup was 26.9 versus 26.7 months. Mean duration of immobilization was 11.6 versus 9.4 weeks (P < 0.001). Improved carrying angle was 6.8° versus 9.7° (P < 0.05). Mean gain in ROM was 17.7° versus 27.5° (P < 0.05). Mean LES was 8.15 versus 8.18 (P > 0.05). Premature closure of physis was observed in two patients. Pin tract infection was seen in three of Group I (P > 0.05). Conclusion: There was no difference in LES, irrespective of implant used. Screw was better in terms of duration of slab, improvement in carrying angle and ROM.
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Patellar resurfacing versus nonresurfacing with patellaplasty in total knee arthroplasty
Sanjay Agarwala, Vivek Shetty, Lnvsl Kishore Karumuri, Mayank Vijayvargiya
July-August 2018, 52(4):393-398
DOI:10.4103/ortho.IJOrtho_512_16  PMID:30078898
Background: Anterior knee pain following total knee arthroplasty (TKA) remains one of the important reasons for patient dissatisfaction. The management of patellofemoral joint is controversial and a decision whether to resurface the patella or not, is important. The present study compares the clinical and radiological outcomes between patellar resurfacing and nonresurfacing in patients undergoing bilateral TKA. Materials and Methods: This is a prospective comparative study with 60 patients undergoing bilateral simultaneous TKA (120 knees) with posterior stabilized Hi flex fixed bearing knee (Zimmer, Warsaw, Indiana), by two surgeons. The patients were allocated to the two groups of resurfacing versus nonresurfacing of patella. In nonresurfacing group, patellaplasty was done. Patients with clinicoradiological signs of tricompartmental arthritis were included in the study. Exclusion criteria included unilateral TKA, rheumatoid arthritis, postseptic arthritis, previous high tibial osteotomy, or unicondylar knee arthroplasty cases. Patients were assessed using Knee Society Score (KSS), Modified Samsung Medical Centre Score (MSMCS), Feller patellar score. Radiological evaluation was performed at 1 year using congruence angle and patellar tilt angle. Results: Mean followup was 19 months (range 12–25 months). Mean KSS, MSMCS, Feller patellar scores in resurfacing group were 82.67, 10.68, and 25.97, respectively and in nonresurfacing group were 82.93, 10.48, and 24.90, respectively. Mean congruence angle in resurfacing group was −12.83° and in nonresurfacing group was −12.383° (P = 0.917) and mean patellar tilt angle in resurfacing is 8.07 and nonresurfacing group is 7.97 (P = 0.873). Conclusion: There was no statistically significant difference in short-term clinical, functional, and radiological outcomes in the two groups and therefore, routine patellar resurfacing for patient undergoing TKA is not advantageous.
  2,154 154 -
Magnetic resonance measurements of sacrococcygeal and intercoccygeal angles in normal participants and those with idiopathic coccydynia
Vishal Gupta, Neema Agarwal, Barin Prasad Baruah
July-August 2018, 52(4):353-357
DOI:10.4103/ortho.IJOrtho_407_16  PMID:30078891
Background: In the past, few studies have been done to objectively measure the sacrococcygeal (SC) and intercoccygeal (IC) angles in the population and in patients with coccydynia. Coccydynia is an age-old disorder, the exact incidence of which has not been determined. It is reported to be more common in females and the obese. The magnetic resonance imaging (MRI) studies done in the past have calculated the curvature indices. In this study, we used MRI to objectively measure the angles in the normal participants as well as those with idiopathic coccydynia. Materials and Methods: Two groups of patients were identified. Group A was “control group” of 106 normal participants and Group B comprised “study group” of ten patients suffering from idiopathic coccydynia. In all these patients, midsagittal T1-weighted MRI image acquired in supine position was used to calculate SC and IC angles. Data were analyzed, and angles were compared between the study and control groups. Statistical analysis was done with Chi-square test. Results: In the control group, the average SC and IC angles in the control group were 126.8° and 33.5°, respectively. In the study group, the average SC angle and the average IC angle turned out to be 127.1° and 43.2°, respectively. The difference between the SC angles in the control and study groups was not significant (P = 0.7), whereas the difference between the IC angles in the two groups was significant (P = 0.002). Conclusions: From our study, we observed that the IC angle shows a decreasing trend with increasing age. In addition, increased IC angle was identified as a possible cause of idiopathic coccydynia.
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Analysis of staged treatment for gustilo anderson IIIB/C open tibial fractures
Rui Hu, Yi-Jun Ren, Li Yan, Xin-Cheng Yi, Fan Ding, Qiong Han, Wen-Jun Cheng
July-August 2018, 52(4):411-417
DOI:10.4103/ortho.IJOrtho_344_16  PMID:30078901
Background: Gustilo Anderson III B/C open tibial fractures are more difficult to manage than I, II, and III A fractures. These open tibial fractures are often associated with wound infection, soft tissue necrosis, bone nonunion, osteomyelitis or amputation. Staged treatment for this severe trauma is very necessary. Materials and Methods: 25 cases of Gustilo Anderson IIIB/C open tibial fractures with serious soft-tissue defects treated between January 2010 and January 2015 were included in this study. The treatment was administered in three stages. The first stage included emergency debridement, external fixation, repair of damaged main blood vessels and nerves, covering of the wound, and infection control. The second stage involved skin flap or skin graft placement to repair wounds. The third stage involved replacement of the external fixator with an internal fixator and the placement of bone grafts. Results: All the skin flaps or skin grafts survived, and a small necrotic area in the distal flap was observed in only two cases (which resolved spontaneously after the dressing was changed). Bone union occurred at the predicted time in 23 cases, while it was delayed in 2 cases. The rate of excellent and good was 88%. Conclusion: Staged treatment was safe and effective for Gustilo Anderson IIIB/C tibial fractures. The timing for the placement of internal and external fixators and choosing the appropriate skin flap repair technique are important.
  2,118 138 -
EDITORIAL
Standard format for writing a manuscript: A guide to authors
Ish Kumar Dhammi, Rehan Ul Haq
July-August 2018, 52(4):341-343
DOI:10.4103/ortho.IJOrtho_323_18  PMID:30078889
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ORIGINAL ARTICLES
Incidence, risk factors, and management of infection following anterior cruciate ligament reconstruction surgery
Ravi Gupta, Munish Sood, Anubhav Malhotra, Gladson David Masih, Mukta Raghav, Tanu Khanna
July-August 2018, 52(4):399-405
DOI:10.4103/ortho.IJOrtho_379_17  PMID:30078899
Background: Infection after anterior cruciate ligament reconstruction surgery (ACLRS) is a rare complication. Although there are number of studies from various Caucasian population but only few studies are available from Asian population. The aim of the study is to assess the incidence, risk factors and, clinical outcome using our treatment protocol. Materials and Methods: Out of 1468 arthroscopic ACLRS, 26 patients with clinical suspicion of infection were critically analysed in terms of laboratory reports of arthrocentesis, erythrocyte sedimentation rate, C-reactive protein and risk factors such as the type of graft, gender, diabetes mellitus, smoking, intraarticular steroid injection, and obesity. At final followup, all these patients were evaluated using visual analog scale (VAS), Lysholm knee score, and Tegner activity level. Results: In nine patients, culture did not show any growth and they showed improvement with arthrocentesis and oral antibiotics. These patients were labeled as suffering from aseptic effusion. In the remaining 17 patients, there was no clinical improvement or instead worsening of symptoms after arthrocentesis and oral antibiotics. These patients were labeled as suffering from an infection and underwent surgical debridement along with administration of injectable antibiotics. The history of intraarticular steroid injection before ACLRS was a significant risk factor for developing infection (P = 0.001). At mean followup of 2.8 years, mean VAS improved to 1.18 ± 0.99 from 6.2 ± 2.3. The mean Lysholm knee score and Tegner's activity level at the final followup were 79.2 ± 10.52 and 4.8 ± 2.30, respectively. Conclusion: The incidence of infection was 1.2% (17/1468). The step-ladder approach of differentiating between aseptic effusion and infection and accordingly, following a treatment protocol, i.e., oral antibiotics alone or surgical debridement along with injectable antibiotics or additional debridement of graft in refractory patients, yielded satisfactory results.
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REVIEW ARTICLE
Grade I osteochondritis dissecans in a young professional athlete
Vinod Kumar, Nishit Bhatnagar, Jeetendra Singh Lodhi
July-August 2018, 52(4):344-352
DOI:10.4103/ortho.IJOrtho_322_17  PMID:30078890
Background: Osteochondritis dissecans (OCD) is a disorder primarily affecting subchondral bone, with secondary effects on the overlying articular cartilage. Knee joint (75%) and radiocapitellar joint (6%) are the most common sites for OCD lesions. The presence of an open growth plate differentiates juvenile osteochondritis dissecans from adult form of osteochondritis. Early diagnosis and treatment produce best long term results. The objective of this study is to determine the best mode of management of a Grade I osteochondritis lesion in a young athlete. Materials and Methods: A PubMed search was made using the keywords “OCD” and “athlete”. Articles that were based on participants between the ages of 6–24 years (children, adolescent and young adult) and early stages of OCD were included in this study. A total of 25 articles were thus included for the review. Results: The healing potential is based on the age of the patient, status of physis, and stage of the lesion. Most authors have observed good to excellent results of drilling of early OCD in skeletally mature patients. Similarly, most authors also reported equally successful outcomes of nonoperative treatment for early OCD in skeletally immature patients. Conclusions: We recommend initial nonoperative line of management in patients with open physis. In case of progression of the lesion or failure of conservative treatment a reparative, restorative or palliative surgical intervention can be done. For Stage I OCD lesions in patients with closed physis, we advocate reparative surgery either by means of retro- or trans-articular drilling.
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ORIGINAL ARTICLES
Is convex derotation equally effective as concave derotation for achieving adequate correction of selective lenke's Type- 1 scoliosis?
Arun-Kumar Kaliya-Perumal, Yu-Cheng Yeh, Chi-Chien Niu, Lih-Huei Chen, Wen-Jer Chen, Po-Liang Lai
July-August 2018, 52(4):363-368
DOI:10.4103/ortho.IJOrtho_447_16  PMID:30078893
Background: Correcting the scoliosis and stabilizing the spine in the corrected position is the basis of treatment for adolescent idiopathic scoliosis (AIS). Spinal instrumentation and derotation are the principle steps of surgery for any type of AIS. A perspicuous understanding needs to be attained regarding derotation maneuvers in practice; therefore, we intend to compare radiological outcomes following concave and convex rod derotation maneuvers to analyze their efficacy to correct selective Lenke's Type-1 scoliosis. Materials and Methods: Retrospectively, 88 patients with Lenke's Type-1 scoliosis who were operated with selective thoracic instrumentation were divided into two groups depending on the derotation side. Preoperative radiographs were analyzed for curve angles, thoracic apical vertebral translation, apical vertebral rotation, and coronal/sagittal balance. Postoperative and followup assessment was focused on curve correction. Correction rate of main thoracic (MT) curve and its corresponding loss of correction at final followup are calculated. Results: Concave group (n = 40; age 13.8 ± 1.9) and the convex group (n = 48; Age 14.3 ± 2.4) showed similar demographic characteristics. Postoperative and followup parameters showed no significant difference. Correction rate of MT curve between both groups (concave group = 69.2 ± 10.5%; convex group = 66 ± 12.8%; P = 0.20) was similar. There was minimal loss of correction at final followup among both groups (concave group = 2.2° ±5.4°; Convex group = 1.5° ± 4.8°; P = 0.52). Conclusion: The study results showed similar sustained satisfactory correction of flexible Lenke's type 1 scoliotic curves irrespective of the derotation maneuver used. Adequate correction, thereby restoring balance was predominantly perceived among the entire sample. Hence, convex derotation can be considered equally effective as that of concave derotation for achieving adequate correction of selective Lenke's Type-1 scoliosis.
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Functional outcome of modified weaver dunn technique for acromioclavicular joint dislocation
Ravi Gupta, Munish Sood, Anubhav Malhotra, Gladson David Masih, Tanu Khanna, Mukta Raghav
July-August 2018, 52(4):418-422
DOI:10.4103/ortho.IJOrtho_469_16  PMID:30078902
Background: The debate about the ideal surgical procedure for acromioclavicular joint (ACJ) dislocation is still unresolved and newer techniques are being evolved continuously. The present study evaluates functional outcome of ACJ reconstruction using the modified Weaver Dunn procedure. Materials and Methods: 35 patients (26 males, 9 females) with ACJ dislocation, between the age group of 18–48 years (mean age 31 years), were operated using modified Weaver Dunn procedure at our center from May 2005 to June 2010. The dominant side was involved in 25 patients (22 right, 13 left). The mean period from the time of injury to the surgery was 14 days (range 4–26 days). All the patients were assessed with Oxford shoulder score and the time required to return to preinjury level was recorded. Results: At the mean followup of 95 months (range 72–120 months), the mean Oxford Shoulder Score improved from 25 ± 7.2 to 43 ± 6.9. 85% (30 out of 35) patients had satisfactory results, while 15% (5 out of 35) had mild shoulder dysfunction using this scoring system. Five patients had radiological evidence of Grade 2 ACJ subluxation. Out of these five patients, two developed ossification around the coracoclavicular ligament. Three patients had intermittent mild pain without any functional disability, and one had a moderate restriction of shoulder movements. Conclusion: ACJ reconstruction, using the modified Weaver Dunn procedure in ACJ dislocation, is a reproducible procedure and provides a good functional outcome.
  1,836 143 -
Midterm results of conversion from failed bipolar hemiarthroplasty to total hip arthroplasty
Kyung-Soon Park, Chee-Ken Chan, Dong-Hyun Lee, Taek-Rim Yoon
July-August 2018, 52(4):369-373
DOI:10.4103/ortho.IJOrtho_494_16  PMID:30078894
Background: Conversion from failed bipolar hemiarthroplasty (HA) to total hip arthroplasty (THA) presents a great challenge to orthopedic surgeons for bipolar head removal and cup placement with or without change of femoral stem. Conversion THA after failed bipolar arthroplasty is known to offer both symptomatic and functional improvement. This study evaluates the midterm functional outcome and complications, especially dislocation associated with femoral head diameter, after conversion THA. Materials and Methods: Forty eight hips with the conversion of bipolar HA to THA were followed up for an average 6.2 years (range 2.0–11.5 years). Twenty one hips had conversion surgery to THA using metal-on-metal articulation (28 or 32 mm head). Nine hips used ceramic-on-ceramic (28–40 mm) and eighteen hips used large head metal-on-metal bearing (>40 mm). Outcome was evaluated using Harris Hip Score (HHS) and Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) score. The radiographs were analyzed for evidence of osteolysis and/or loosening. The complications were evaluated, especially dislocation with different femoral head diameter. Results: Average HHS significantly improved from 42 preoperatively to 86 postoperatively and the average WOMAC score also significantly improved from 47 to 22 postoperatively. Radiological evaluation showed all the femoral components were stable. There was one acetabular component loosening, which required revision 9 years after conversion to THA. One dislocation and one recurrent dislocation were recorded in isolated acetabular revision hip; whereas one dislocation, one recurrent dislocation, and one trochanteric nonunion occurred in the hips with revision of both components. All dislocations occurred in hips with a femoral head size of 28 mm (P = 0.052). The cup and femoral head interval length was the most significant factor contributing to dislocation (P = 0.013). Conclusions: Conversion THA after failed bipolar HA offers a reliable pain relief and functional improvement. To prevent dislocation, it is highly recommended to use a larger diameter femoral head, especially where the cup size is big.
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A comparative study of decompressive laminectomy and posterior lumbar interbody fusion in Grade I degenerative lumbar spondylolisthesis
Sang-Il Kim, Kee-Yong Ha, Young-Hoon Kim, Young-Ho Kim, In-Soo Oh
July-August 2018, 52(4):358-362
DOI:10.4103/ortho.IJOrtho_330_16  PMID:30078892
Background: For Grade I degenerative lumbar spondylolisthesis (DLS), both decompression alone and decompression with fusion are effective surgical treatments. Which of the two techniques is superior is still under debate. The purpose of this study was to compare clinical outcomes after decompression alone versus decompression with fusion for Grade I DLS. Materials and Methods: 139 patients who underwent surgery for Grade I DLS at L4-L5 were prospectively enrolled. Decompression alone was used to treat 74 patients, and decompression with fusion was used to treat 65 patients. Six patients in the first group and four patients in the second group were lost during the 2-year followup. Demographic data were recorded. Operation time, perioperative blood loss, total blood transfusion volume, and length of hospital stay were compared between the two groups. Back pain and functional outcomes were evaluated using the visual analog scale (VAS) and the Oswestry Disability Index (ODI), respectively. Results: Baseline demographic data were not different between the two groups. Operation time, blood loss, total blood transfusion volume, and length of hospital stay were all significantly greater in the fusion group than in the decompression group. This would be expected because fusion is the more invasive procedure. VAS scores were not different up until 6 months postoperatively. Twelve months after surgery, however, VAS scores were significantly lower in the fusion group. The same results were shown in terms of ODI. Although ODI decreased in both groups over time, the fusion group showed better functional outcomes than did the decompression group. Conclusions: Although both decompression alone and decompression with fusion improved functional outcomes for Grade I DLS, fusion surgery resulted in better results compared to decompression alone. Therefore, fusion should be considered as the treatment of choice for Grade I DLS.
  1,457 115 -
Does the surgeon-reported outcome correlate with patient-reported outcome after total knee arthroplasty? A cohort study
Sivashanmugam Raju, Karthikeyan Chinnakkannu, Ashok Selvaraj, Balasubramanian Balakumar, Mohan K Puttaswamy, PV Jayasankar
July-August 2018, 52(4):387-392
DOI:10.4103/ortho.IJOrtho_359_16  PMID:30078897
Background: Total knee arthroplasty (TKA) has been proved to be a successful and cost-effective treatment for improving pain and function in patients with knee arthritis. Total knee arthroplasty (TKA) is one of the most common orthopaedic surgeries performed worldwide and advancement in surgical techniques and prosthetic designs have improved the patient outcomes. However, concerns and priorities of patients and surgeons relating to joint replacement may differ. Materials and Methods: 306 TKAs in 223 patients were evaluated for functional outcome using surgeon reported American Knee Society Knee Score (KS)/Functional Score (FS) and patient-reported Oxford Knee Score (OKS). We have also assessed the correlation between FS and OKS at midterm follow up. Results: The mean preoperative KS, FS, and OKS in 223 patients were 42.76, 42.4, and 38.84 and the midterm mean KS, FS, and OKS were 84.29, 73.40, and 30.26, respectively. There was a statistically significant improvement in the KS, FS, and OKS at midterm follow up in Category A (CAT A) (bilateral TKA or unilateral with asymptomatic contralateral knee), CAT B (unilateral TKA with symptomatic other knee) and CAT C (inflammatory arthritis). Overall, the correlation between the midterm FS and OKS was fair. However, in CAT A and CAT B, there was no significant correlation between FS and OKS, but CAT C had a strong correlation. There was a statistically significant improvement in the KS, FS, and OKS when midterm follow up scores were compared with preoperative scores. However, no significant correlation between the American knee society FS and OKS in osteoarthritic patients at midterm follow up signifies acceptable outcome may vary between patients and physicians. Conclusion: All patients should be counseled preoperatively to assess their expectations and sensitize them to information regarding the expected functional outcome following TKA in their cultural context.
  1,456 93 -
Gustilo IIIB open tibial fractures: An analysis of infection and nonunion rates
Amritpal Singh, Jonathan Tan Jiong Hao, Desmond Tan Wei, Chua Wei Liang, Diarmuid Murphy, Joseph Thambiah, Chee Yu Han
July-August 2018, 52(4):406-410
DOI:10.4103/ortho.IJOrtho_369_16  PMID:30078900
Background: Gustilo IIIB tibial fractures are associated with high rates of infection and nonunion. This study evaluates the impact of factors such as patient demographics, mechanism of injury, time to the first debridement, and time to flap coverage on the union and infection rates. Materials and Methods: A retrospective analysis was performed on all patients with open tibial fractures who presented to our tertiary trauma center over 13 years from April 2000 to August 2013. All patients were followed for at least 6 months and continued till radiographic evidence of union (maximum 72 months). Time to fracture union was based on radiological evidence of callus bridging at least three cortices. Information on infection rates and the presence of microbes were evaluated. Results: A total of 120 patients were analyzed. The mean time to fracture union was 33.8 weeks. Younger age was associated with a lower risk of nonunion with the mean age being 30.4 years in union group compared to 38.2 in the delayed-union group. Smoking was associated with an increased risk of delayed union with revision surgery being needed in 61.5% of smokers compared to 36.4% in nonsmokers. Rates of infection were high at 30.3%. Smoking was associated with an increased risk of infection (65.4% vs. 24.7%). Conclusion: High-energy open tibia fractures required an average of 8.5 months to heal and delayed or nonunion at an earlier juncture cannot be assumed.
  1,358 149 -
Results of crowe Type IV developmental dysplasia of hip treated by subtrochantric osteotomy and total hip arthroplasty
Murat Altay, İsmail Demirkale, Mehmet Faruk Çatma, Hakan Şeşen, Serhan Ünlü, Mert Karaduman
July-August 2018, 52(4):374-379
DOI:10.4103/ortho.IJOrtho_445_16  PMID:30078895
Background: Crowe type IV developmental dysplasia of hip (DDH), subtrochanteric shortening osteotomy is required to restore the hip joint. Several approaches have been described for subtrochanteric shortening osteotomy. Several osteotomy fixation techniques have been defined for Crowe type IV DDH. This study evaluates the outcomes of subtrochanteric shortening osteotomy fixed with a combination of split onlay autograft and distal fluted femoral stem. Materials and Methods: A retrospective study was carried out on 41 hips of 37 patients treated with total hip replacement for Crowe type IV developmental dysplasia of the hip by subtrochanteric transverse osteotomy and fixed with split intercalary autograft by two cables. A femoral stem with proximal coated and distally fluted was used. The patients were evaluated at a mean of 34 months (range 12–68 months) for union time, leg equalization, and clinical outcomes. Results: Mean time of union was 13.5 ± 4.6 weeks (range 6–24 weeks). Intraoperative instability of the osteotomy site (n = 16) that was encountered at the trial stage was restored properly by this surgical protocol. Leg length discrepancies were improved to 1.4 ± 0.8 cm (range 0–3 cm). Harris scores were improved from 47.7 ± 10.8 (range 30–68) to 88 ± 5.6 (range 72–98) (P < 0.05) points. There was no nonunion. Conclusions: Distally well-fitted stem and strengthening of fixation with split intercalary autograft promote additional rotational stability and improve bone union.
  1,405 79 -
LETTERS TO THE EDITOR
Submission to publication demystified: A guide for authors
Raju Vaishya
July-August 2018, 52(4):438-438
DOI:10.4103/ortho.IJOrtho_7_18  PMID:30078906
  1,080 63 -
CASE REPORT
Snapping phenomenon after revisional total knee arthroplasty
Jae-Hyuk Yang, Jung-Ro Yoon
July-August 2018, 52(4):434-437
DOI:10.4103/ortho.IJOrtho_314_17  PMID:30078905
The cases of revision total knee arthroplasty (TKA) are increasing. In this report, snapping phenomenon after final implantation of revision TKA has been presented. Snapping was caused by adhered iliotibial band (ITB) impinging against the lateral part of femoral component. Fractional lengthening the ITB by puncture resolved the snapping phenomenon. Surgeons should be aware of the presence of such a case which should be identified during operation to avoid secondary operations.
  1,071 59 -
ORIGINAL ARTICLES
Effectiveness of strontium ranelate in the treatment of rat model of legg–calve–perthes disease
Yu-Pin Chen, Amyla Tan, Wei-Pin Ho, Tai-Yuan Chuang, Wei-Chuan Chen, Chih-Hwa Chen
July-August 2018, 52(4):380-386
DOI:10.4103/ortho.IJOrtho_437_16  PMID:30078896
Background: Legg–Calve–Perthes disease (LCPD) causes osteonecrosis of the femoral head (ONFH) by temporarily interrupting the blood supply in children. Even with potential toward bone regeneration and revascularization in LCPD, the prognosis depends on the deformity of femoral heads, and successful rate with the current treatments varies. Antiresorptive therapy such as bisphosphonate, which maintains mechanical stability of the femoral head by inhibiting necrotic bone resorption, has proven effective in animal models. However, concerns on simultaneous decline in bone turnover rate still leave room for improvement. Strontium ranelate with dual effect on inhibiting bone resorption and accelerating bone formation is presumed to be an ideal therapy for reserving sphericity of femoral heads in LCPD. Materials and Methods: In this study of a rat model of ONFH, randomized groups of rats treated with strontium ranelate or normal saline are compared at different time points in analysis of radiological, histological, and bone morphometric changes. Gait analysis was also compared between the two groups. Results: The group treated with strontium ranelate recovered their normal gait earlier than the control group did. Bone density, trabecular thickness, sphericity of the femoral head, and bone regeneration potential were also preserved in the strontium ranelate group. Conclusion: Strontium ranelate effectively prevented collapse of the ischemic femoral head and enhanced trabecular thickness in the rat model of LCPD. Hopefully, this preclinical experiment can improve the effectiveness of strontium ranelate treatment for pediatric ONFH.
  1,068 40 -
PROFILE
Legends of Indian Orthopedics: Prof. B. N. Sinha
Vineet Sharma, Bhavuk Garg
July-August 2018, 52(4):443-444
DOI:10.4103/ortho.IJOrtho_333_18  PMID:30078908
  1,009 55 -
ORIGINAL ARTICLES
The reperfusion delay in finger replantation by vein arterialization
Ping Zhang, Chunping Zhu, Jingchun Xiao, Youqing Zhou
July-August 2018, 52(4):430-433
DOI:10.4103/ortho.IJOrtho_341_16  PMID:30078904
Background: Extensive arterial damage of arteries that were too small in diameter precluded finger replantation. Venous arterialization in which arterial blood inflows through a proximal arterial-to-distal venous anastomosis, allows performing replantation that was previously considered as impossible and has resulted in a successful outcome. The aim is to introduce the distinctive phenomenon of the reperfusion delay in finger replantation by vein arterialization and to analyze its clinical significance. Materials and Methods: In 2012–2015, vein arterialization was involved in 18 digits of 13 patients. The duration that the replants restore reperfusion following the release of tourniquet, defined as revascularization time, was recorded. Results: The results showed that revascularization time ranged from 0 to 540 min, with an average of 54.5 min. The revascularization time was shorter than 20 min in 8 digits, between 20 and 120 min in 9 digits, and 540 min in one digit. Conclusion: The study findings have shown that reperfusion delay is usual during vein arterialization. Failing to understand it would result in the premature endings of the procedure. It is worth maintaining further observation, thus rescue otherwise possibly abandoned replantation.
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NOTICE OF RETRACTION
Retraction: Evaluation of a modified POSSUM scoring system for predicting the morbidity in patients undergoing lumbar surgery

July-August 2018, 52(4):445-445
DOI:10.4103/0019-5413.236134  PMID:30078909
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LETTERS TO THE EDITOR
Author reply
Ish Kumar Dhammi, Rehan Ul Haq
July-August 2018, 52(4):439-440
DOI:10.4103/ortho.IJOrtho_47_18  PMID:30078907
  741 33 -
BOOK REVIEW
The ASSI Monographs: Complications in spine surgery, ankylosing spondylitis, lumbar spinal stenosis
Anil K Jain
July-August 2018, 52(4):441-442
DOI:10.4103/ortho.IJOrtho_263_18  
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