Journal of Clinical Orthopaedics & Trauma

Living in the shadow of fear

Gurinder Bedi — 2011-12-01

The floating knee injury

Ritabh Kumar — 2011-12-01

Abstract: Floating knee injury is described as the simultaneous ipsilateral disruption of skeletal integrity above and below the knee. It is usually associated with high-energy impact and often a part of polytrauma. Management of associated life-threatening injuries should take precedence over the orthopedic injury. The soft tissue trauma to the limb is significant and it is prudent to be wary. Despite a high complication rate, early skeletal stabilization and timely postoperative rehabilitation offer the best chance of a favorable outcome.

Patellar resurfacing in total knee arthroplasty

Mayank Agrawal, Vineet Jain, Ved Pal Yadav, Vikas Bhardwaj — 2011-12-01

Abstract: Patellar resurfacing in total knee arthroplasty remains controversial as there is evidence both in favor of and against routine resurfacing. We aimed to evaluate the effectiveness of this technique through a critical appraisal of the available literature. We performed a review of all available randomized controlled trials (RCTs) on MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials, and compared total knee arthroplasties performed with and without patellar resurfacing. References of retrieved articles were also reviewed regardless of the study is whether for total knee arthroplasty, surgical technique, or specific types of prosthesis used. There was no language restriction at the time of search. Outcomes of interest included incidence of reoperations, prevalence of postoperative anterior knee pain, and improvement in various knee scores. The relative risk of reoperation is significantly lower in the patellar resurfacing group than the nonresurfacing group (RR: 0.52, 95% CI). The possibility of anterior knee pain is also reduced in patellar resurfacing group compared to nonresurfacing group with the RR of 0.56 (95% CI, P < 0.00001) with no significant difference in functional outcome between the two groups. The existing literature shows that patellar resurfacing can reduce the risk of reoperation with no improvement in knee function or patient satisfaction compared to patients without patellar resurfacing. If it reduces, the incidence of anterior knee pain remains uncertain at present.

Sternocleidomastoid pseudotumor and congenital muscular torticollis

Anil Agarwal, Indreshwar Verma — 2011-12-01

Shoulder injury in athletes

Gurinder Bedi — 2011-12-01

Abstract: Shoulder injuries are extremely common in sportspeople involved in overhead sports and even in casual sportspersons. With increasing interest in activities such as tennis, golf, squash, badminton not to mention cricket, many of our colleagues are seeing a lot of these individuals with disabling pains. Many unnecessary investigations are being done where most diagnosis can be made by good clinical examination and knowledge of pathology. Therapy plays a very important part in the rehabilitation of these injuries, although again certain protocols have to be followed. The review will look at some of the common pathologies and also treatment options and also some specific injuries related to few sports.

Yoga and orthopedics

John Ebnezar — 2011-12-01

Abstract: Orthopedic problems are on the rise owing to the rapid urbanization, increased incidences of road traffic accidents and natural calamities. Stress has corroded human existence and is making the modern treatment methods ineffective. Orthopedic lifestyle disorders are on an unprecedented high. We genuinely need a treatment method that can help us treat the physical aspects of the various musculoskeletal health problems including trauma and also help us combat the associated mental and emotional health problems. Extensive research has now shown that yoga may be an ideal treatment method that can help tackle all the modern day orthopedic health problems.

Prospective comparative study of functional outcome of treatment of tibial shaft fracture in adult by cast versus intramedullary nailing

Abhijan Maity, Abhigyan Mondal, Bikash Chandra Mondal, Debasish Sinha Roy — 2011-12-01

The results of two-staged operative management of pilon fractures–a review of 25 cases

2011-12-01

Abstract: To evaluate the two-staged operative fixation of Arbeitsgemeinschaft für Osteosynthesefragen/Orthopedic Trauma Association (AO/OTA) type C pilon fractures. Retrospective review of prospectively collected data. Twenty-five consecutive patients with AO/OTA type C pilon fractures. All the patients underwent immediate application of external fixator spanning the ankle joint and internal fixation of fibular fracture. After a mean duration of 12 days, the external fixator was removed and internal fixation of pilon fracture was performed. At average follow-up of 18 months, all patients were evaluated by using subjective, objective, and radiographic measurements as described by Burwell and Charnley. Range of motion and postoperative complications were also recorded. Twenty-three of the 25 fractures healed within an average of 4 months. Average range of motion was 7° of dorsiflexion, 31° of plantar flexion, 11° of eversion, and 13° of inversion. Subjective and objective measurements showed 80% good results, 12% fair results, and 8% poor results. Radiographs showed anatomic reduction in 84% cases and fair reduction in another 16% cases. There were no infections or soft tissue complications. The arthrodesis rate was 4%. A two-staged approach offers good outcome for the treatment of AO/OTA type C pilon fractures.

Comparison of abduction brace and surgical containment in management of Perthes disease

Sambit Kumar Panda, Akash Sabharwal, Saurabh Kapoor, Aman Goyal, J Sahoo — 2011-12-01

Abstract: The approach in management of Perthes disease attempts to prevent the femoral head from bearing forces across the acetabular margin by either preventing or reversing extrusion of the femoral head. Once the diagnosis is established, the primary aim of treatment of Legg-Calve-Perthes disease is containment of femoral head within the acetabulum. Containment can be achieved either conservatively or surgically. If this is achieved, the femoral head can reform in a concentric manner by what Salter has termed as “biological plasticity”. Thirty-six patients with Perthes disease were thoroughly evaluated both clinically and radiologically following admission and were divided into 2 groups in a randomized trial. Eighteen patients in group I received conservative treatment with a weight-relieving caliper, a modification of ambulation-abduction brace designed in our institute. Equal number of patients in group II were treated by surgical methods to bring the subluxated head inside the acetabulum for containment. Of the 18 patients in group II, 9 patients were undergone Axer's osteotomy and another 9 patients were treated by trochanteric bifurcation osteotomy with lateral advancement of trochanter and the bifurcation is maintained by autogenous ipsilateral fibular graft. The follow-up period is 2 years. We lost follow-up of 1 patient in group I, 1 from Axer's osteotomy, and 3 from trochanteric advancement group. Another 5 patients in group III were not treated but followed up similar to groups I and II in this study. It is evident from the overall result of different groups that 64% of good results were observed in group I, followed by group II (50%) and group III (20%). Fair results were observed at 50% in group II, followed by group III (40%) and group I (18%). There was no evidence of poor results in group II, whereas it was 40% in group III and 20% in group I. Our maximum percentage of good results was observed in the conservative group and in the untreated group the percentage of good results is as low as 20%. Fair results were almost the same in all 3 groups, irrespective of type of treatment. Clinical and radiological outcome in both conservative and surgical containment group is similar, although the Axer's osteotomy group has an extra burden of shortening and limping, and requires a second surgery for plate removal.

Traumatic neglected posterior dislocation of shoulder in a child–a rare entity

Yashavantha Kumar, Anand Verma, Lalit Maini, VK Gautam — 2011-12-01

Osteofibrous dysplasia–an unusual presentation of rare entity

Arvind P Gupta, Pallav Mishra, Abhishek Bansal, Himanshu Gupta, Vineet Jain — 2011-12-01

The ‘floating elbow’ in children and the additional fracture–report of two cases

Anil Agarwal — 2011-12-01

Osteomyelitis variolosa misdiagnosed as rheumatoid arthritis

Purandarnath, Balaji Douraiswami — 2011-12-01

Weight loss for obese patients prior to total knee replacement

WS Borland, AG Jennings — 2011-12-01