Locking plates have been especially useful in the treatment of osteoporotic fractures. This study aimed to investigate the role of locking plate in femoral fractures in patients with osteogenesis imperfecta. 6 male patients with osteogenesis imperfecta were operated for femoral fractures using locking compression plate. Their age ranged between 4 and 14 years. They were kept non weight bearing till the fracture united.Introduction
Material & Methods
We compared standard NexGen Cruciate substituting-flex prosthesis with gender-specific NexGen Cruciate substituting flex prosthesis in patients undergoing bilateral total knee arthroplasty with regard to Coverage of the bone by femoral component, Clinical outcome, Radiographic outcome, Survival and complication rates, with special emphasis on patellofemoral complications. 30 female patients with osteo-arthritis of the knees with similar deformity and preoperative range of motion were randomized to have one knee replaced with a gender non-specific Nexgen Cruciate substituting (Zimmer) prosthesis and the other with Gender Cruciate substituting (Zimmer) prosthesis. Follow-up clinical evaluation was done at 6, and 12 months postoperatively and then at yearly interval using “Knee Society” Recommendations. Clinical assessment of the patellofemoral joint of the replaced knees was done with the help of “Hospital for Special Surgery” patellar scoring system. The overall patient satisfaction after surgery was evaluated with use of the British Orthopaedic Association patient satisfaction score.Introduction
Material & Methods
Tranexamic acid is an inhibitor of fibrinolysis that blocks the lysine-binding site of plasminogen to fibrin, and thereby decreases blood loss in patients undergoing surgery. A prospective, randomized, double-blind study was done on 100 patients undergoing primary cemented Unilateral Total Knee Arthroplasty to determine the effect of tranexamic acid on intra- and postoperative blood losses and on the transfusions requirements.Introduction
Aims and objectives
25 patients in age group (25–40yrs), 15 males, 10 females were implanted with a short metaphyseal cementless stem (‘Proxima’®, Depuy) and cementless acetabular cup. The average follow up was 2.3 years (1.4–2.5 yrs). Clinical evaluation using Harris Hip Score, Radiological evaluation and Bone Mineral Density were evaluated at 2weeks, 6 months, 12 months and yearly thereafter. a new zonal method suitable for short stem was used for radiological evaluation. The mean Harris Hip score improved from 44 to 95 at final follow up. There was no evidence of any radiolucent lines or osteolysis around the stems. All the stems showed evidence of osseointegration at one year follow up. There was no decrease in bone mineral density around the stems. The Short Metaphyseal cementless femoral stem is a bone conserving as well as bone preserving option for young patients especially in those in whom surface replacement is not an option.
Twenty total hip arthroplasty were performed with use of a cementless cup in 17 patients and cemented cup in a cage in 3 patients for the treatment of posttraumatic osteoarthritis following acetabular fracture. The average age of the 4 women and 16 men was 49 (range, 26 to 86 years) at the time of the arthroplasty. The median interval between the time of injury and the total hip arthroplasty was 37 months (range, 8 to 144 months). The average operative time was 120 minutes and average intraoperative blood loss was 700 ml. Eight patients had previous open reduction and internal fixation of the acetabular fracture and twelve had been treated nonoperatively. Following total hip replacement, each patient was evaluated clinically and radiographically at six weeks, three months, six months and twelve months, and then yearly following total hip replacement. The average duration of clinical and radiographic follow-up was 40 months (range, 26 to 60 months). At the time of final follow-up, of twenty acetabular components, 10 had no evidence of periacetabular radiolucency, 7 components had a partial radiolucency that was <1 mm wide, 2 had a complete radiolucency <1 mm wide and 1 component was surrounded by a complete radiolucency of >2 mm in width without showing component migration. According to Engh's criteria, 16 (80%) femoral stems had bony ingrowth and 4 (20%) stems had stable fibrous ingrowth. The average preoperative Harris hip score improved from 35 points to 78 points at the time of final followup. Total hip arthroplasty for arthritis following acetabular fractures, technically difficult because of extensive scarring, heterotopic bone, retained internal fixation devices, and residual deformity of the acetabulum.
Grade is the most important predictor of the biological behaviour of soft tissue sarcomas. Assigning a pathologic grade is always a difficult task as discordance rate is 30-40% even among experienced sarcoma pathologists. Many of these tumours are heterogeneously large and only small fractions are sampled for biopsy. This emphasizes the need for an objective and accurate assessment of histology. Our aim is to evaluate the role of Choline as a tumour marker in (i) differentiating benign from malignant soft tissue tumour, (ii) to distinguish recurrent/residual tumours using in-vivo MR spectroscopy. PMRS Study was performed at 1.5Tesla MRI machine of the lesions in 25 patients. Single-voxel (SVS) study has been done in 10 cases and chemical shift imaging (CSI) study characterised the heterogeneity of the tumour in 15 cases by using point – resolved spectroscopic sequence (PRESS) with echo time TR=2000/TE = 30, 135 & 270 msec. The choline peak, identified at 3.2 ppm in spectra was considered significant. MRS results and histopathologic findings were correlated and P < 0.001, considered being significant.Aim
Methods
We conducted a retrospective study to compare the blood loss following Primary Total Knee Replacement (TKR) to see effectiveness of Tranexamic acid (TXA).v/s Cell Salvage. This was a retrospective study conducted from Aug 2008 to Dec 2009. We compared two groups. Group A was given TXA IV (two doses – first dose before tourniquet release and second dose six hours post-operative) and in group B post op cell salvage was used. 84 knees were included in this study with 42 patients in each group. The surgical technique, implants used and post-operative Thromboprophylaxis care were same in both groups. The corrected mean Hob drop in Group A was 1.76g/dl (Range-0.7 to 4.3) while that in Group B was 2.32g/dl (Range-0.7 to 5.3). Use of TXA lead to a 24.13% decrease in mean Hob drop and 3.7% fall in mean drain output following TKR in our study. Two thromboembolic events in the form of deep vein thrombosis (DVT) confirmed by Duplex US scan, were noted in each group. There was no difference in complication rate i.e. drain site infection and wound leaking in either group. Costs - The cost of two doses of TXA is £3.81 per patient and cost of bellovac drain was £85 per patient. We found TXA was more effective and cheaper than autolougus blood transfusion and there was no increase in thromboembolic complications
Grade is the most important predictor of the biological behaviour of soft tissue sarcomas. Assigning a pathologic grade is always a difficult task as discordance rate is 30-40% even among experienced sarcoma pathologists. Many of these tumours are heterogeneously large and only small fractions are sampled for biopsy. This emphasizes the need for an objective and accurate assessment of histology. Our aim is to evaluate the role of Choline as a tumour marker in (i) differentiating benign from malignant soft tissue tumour, (ii) to distinguish recurrent/residual tumours using in-vivo MR spectroscopy. PMRS Study was performed at 1.5Tesla MRI machine of the lesions in 25 patients. Single-voxel (SVS) study has been done in 10 cases and chemical shift imaging (CSI) study characterised the heterogeneity of the tumour in 15 cases by using point – resolved spectroscopic sequence (PRESS) with echo time TR=2000/TE = 30, 135 & 270 msec. The choline peak, identified at 3.2 ppm in spectra was considered significant. MRS results and histopathologic findings were correlated and P < 0.001, considered being significant.Aim
Methods
To compare clinical parameters associated with medial parapatellar and midvastus approaches for total knee arthroplasty in the early post-operative period. We present a prospective observational study of 77 patients undergoing primary total knee arthroplasty using medial parapatellar(40) or midvastus approach(37). The prosthetic design and physical intervention was standardised in all the patents. The Oxford Knee Score, pain scale, knee flexion, unassisted straight leg raise, standing and walking were compared at 3rd, 5th and 7th day post-operatively, then at 6 weeks and at 3 months. The patients and physiotherapist were blinded to the type of approach used. The average age was 67 years (range 42 to 88). There were 42 women and 35 men. The average hospital stay was 7 days (range 2 to 15). There was statistically significant difference in duration of hospital stay, unassisted straight leg raise and standing at 3 days (p=0.001) and pain scale at 5 days, all in favour of midvastus approach. There was no statistically significant difference in Oxford Knee Scores and duration to achieving full flexion and walking. The average duration to achieving straight leg raise for the midvastus group was 5 days and for the medial parapatellar approach group was 8 days.Objective
Methods and results
The purpose of this study is to evaluate the early functional outcome and activity level in athletes and soldiers with large full thickness cartilage defects of the knee that underwent either ‘classic’ autologous chondrocyte implantation using periosteal flap coverage (ACI-P) or 3-D matrix-assisted chondrocyte implantation (ACI-M). Between April 2002 and January 2004, 19 patients (15 male, 4 female, average age 32.2 years) with 22 full-thickness cartilage defects in 19 knees were treated with ACI in our centre. The mean post-injury interval was 39.8 months whereas 17 (89.5%) patients had undergone at least one surgical procedure before ACI. The average defect size was 6.54 cm2 (located in MFC:7, LFC:7 or trochlear:2 while 3 patients had bifocal lesions in both LFC and TRC). Novocart¯ cultured chondrocytes with periosteal flap coverage were used in 11 patients and Novocart-3D¯ cell impregnated collagen patch in 8. The functional outcome was evaluated with IKDC form, Tegner activity scale and Lysholm score after a mean follow-up period of 26.5 months.Introduction
Methods
The aim of this study was to compare the diagnostic accuracy of the Magnetic Resonance Imaging with that of Stress views of the ankle in testing the integrity of the lateral ankle ligaments. Arthroscopic diagnosis was used as the gold standard. This was a prospective study involving 45 patients who had previous trauma to the ankle and reported symptoms of ankle instability. Our patients were recreational athletes or military patients. These patients had MRI evaluation prior to arthroscopic evaluation and treatment of the ankle. The diagnosis regarding the integrity of the Calcaneofibular ligament (CFL) and the Anterior Talo-fibular ligament (ATFL), as obtained from the MRI was compared against the assessment of integrity from the stress views. These were compared against the assessment made by direct visualisation of the ligaments during arthroscopy. The sensitivity, specificity, negative (NPV) and positive predictive values (PPV) and accuracy were then calculated.Aim
Methods
Chronic infection of bone with nonunion is traditionally treated by a 2-stage procedure involving initial debridement and antibiotic delivery and then definitive internal fixation. Alternatively, external fixators are used to provide stability. A technique with which single stage antibiotic cement-coated intramedullary nails are prepared in the operating room with the use of Kuntscher Nails and materials that generally are available is described herein. Although useful for all infected nonunions this technique is particularly useful for patients who are not ideal candidates for external fixation and for those who do not want to have an external fixator applied. We evaluated 10 cases treated with antibiotic cement-coated K nail with application of an additional unicortical plate in 7 cases. Autologous iliac crest bone grafting was done in all cases and additional bone substitutes used in 2 cases. 9 patients had stable union with complete control of infection. One patient had persistent infection at the time of last follow
Ossyfying periarticular lipoma is a very rare entity. Lipomas undergo involutional changes like chondrification, calcification and very rarely ossification. These changes result in altered clinical, radiological and histopathological features leading to diagnostic challenge in differentiation from the soft tissue tumor like synovial sarcoma, liposarcoma and rhabdomyosarcoma. We present a series of three cases of ossifying lipomas presenting as soft tissue tumor around the knee, shoulder and hip joints. All the tumors revealed calcification and ossification on plain X-rays and on MRI/CT Scans. Clinico-radiological evaluation lead to a similar diagnostic dilemma in our series and a confirmed diagnosis of ossifying lipoma became possible only after histopathology. All the three tumors were excised completely without any recurrence during last 3 1/2 years of follow-up. We recommend the early imaging by MRI/CT scan with closed core biopsy to exclude the malignant pathology and complete excision of the tumor with early mobilization of the adjacent joint.