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Femoral shaft fractures are fairly common injuries in paediatric age group. The treatment protocols are clear in patients of age less than 4 years and greater than 6 years. The real dilemma lies in the age group of 4–6 years. The aim of this study is to find whether a conservative line should be followed, or a more aggressive surgical intervention can provide significantly better results in these injuries.

This study was conducted in a tertiary care hospital in Bhubaneswar, India from January 2020 to March 2021. A total of 40 patients with femur shaft fractures were included and randomly divided in two treatment groups. Group A were treated with a TENS nail while group B were treated with skin traction followed by spica cast. They were regularly followed up with clinical and radiological examination to look out for signs of healing and any complications. TENS was removed at 4–9 months’ time in all Group A patients.

Group A patients had a statistically significant less hospital stay, immobilisation period, time to full weight bearing and radiological union. Rotational malunions were significantly lower in Group A (p-value 0.0379) while there was no statistically significant difference in angular malunion in coronal and sagittal plane at final follow up. Complications unique to group A were skin necrosis and infection.

We conclude that TENS is better modality for treatment of shaft of femur fractures in patients of 4–6 years age as they significantly reduce the hospital stay, immobilization period and rotational malalignment.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_11 | Pages 10 - 10
1 Nov 2022
Jain H Raichandani K Singh A
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Abstract

INTRODUCTION

Fracture neck of femur is aptly called as “the fracture of necessity” owing to the various factors responsible for its non-union. Pauwel's inter-trochantric valgus osteotomy is a useful approach to deal with such fractures.

AIM

The aim of this study is to evaluate the functional outcome of valgus osteotomy in treatment of neglected and non-union fracture neck of femur using Harris Hip Scoring system (HHS).


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_27 | Pages 2 - 2
1 Jul 2013
Alrub ZA Singh A Berg A Cooke N
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National guidelines suggest which investigations should be performed for patients admitted with an acute hip fracture. We have observed practice often deviates from these guidelines. Our study aims to identify the incidence of deviation with regards to blood investigations and review the effect of deviation on management, and the financial burden on the healthcare system.

A total of 250 acute hip fracture admissions over 12-months period reviewed retrospectively. Admission blood tests, time of presentation, and time of operation were recorded. The cost of admission blood investigations was calculated.

Seventy-nine percent of admissions had one or more non-routine blood investigation tested. Twenty-Nine percent of these tests had abnormal results and these were found to be clinically relevant in 6% of patients. The most commonly requested non-routine investigations were: LFT in 79%, Coagulation screen in 56%, and CRP in 48%. Fifteen percent of patients did not have surgery within the time frame of 36 hours. The total cost of non-routine investigations was £1995.04.

Deviation from admission investigations guidelines for hip fractures without clinical indication adds little clinical value, has no effect on management, and can be a potential cause of unnecessary investigations. This in turn leads to further delays and extra costs.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_7 | Pages 21 - 21
1 Feb 2013
Singh A Montgomery R
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Introduction

We describe a minimally invasive technique that permits intra-focal bone graft of non-union sites with minimal disturbance of soft tissues and vascularity, and present the results of this technique.

Materials and Methods

10 patients with established tibia fracture non-union were judged suitable for the technique, and were treated in our limb reconstruction unit between January 1995 to June 2007. Eight patients were male, 2 were females with a mean age of 37.4 years (27–64). Five fractures were in the distal tibia and five were diaphyseal fractures. Five fractures were as a result of high velocity and 6 fractures were open. Average number of previous operations were 3 (range 1–7). Time lapse between injury to trephine grafting procedure was mean of 34 (6–168 months)

5 patients had a sedentary job, 2 were labourers and 2 were not working. There were 5 smokers and 2 obese patients. Six cases were of infected non-unions.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_1 | Pages 41 - 41
1 Jan 2013
Singh A Pimple M Tavakkolizadeh A Sinha J
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Hypothesis

Recurrent shoulder dislocation is associated with bony defect of the glenoid rim, commonly seen along with bankart tear - a soft tissue injury of glenoid labrum. This cadaveric study compares the bone block effect of coracoid transfer using using two common techniques, Classical Latarjet technique and the Congruent-Arc Latarjet. We hypothesized that the force needed to dislocate the shoulder would be greater in Congruent Arc technique than the Classical Latarjet, because of increased contact surface area as a result of greater linear dimensions.

Material and methods

We dissected 14 cadaveric shoulders. A bony Bankart lesion was created in form of an inverted pear glenoid. The humeral head was attached to a pulley system that was sequentially loaded until the shoulder dislocated anteriorly. The force needed to dislocate was noted. This was repeated after coracoid transfer with two common techniques, Classical Latarjet technique and the Congruent-Arc Latarjet.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_1 | Pages 98 - 98
1 Jan 2013
Singh A Manning W Duffy P Scott S
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Objective

To evaluate the volume of cases, causes of failure, complications in patients with a failed Thompson hemiarthroplasty.

Methods

A retrospective review was undertaken between 2005–11, of all Thompson implant revised in the trust. Patients were identified by clinical coding. All case notes were reviewed.

Data collection included patients demographic, time to revision, reason for revision, type of revision implant, surgical time and technique, transfusion, complications, HDU stay, mobility pre and post revision,


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIX | Pages 152 - 152
1 Sep 2012
Singh A Roshan A Ram S
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Congenital talipes equinovarus occurs in 1.2 per 1000 live births in Europe and is twice as common in boys. Over the last decade, non-surgical management has re-established itself as the first line treatment; after long-term follow-up of surgically treated patients, revealed high rates of over correction, stiffness and pain. The commonly practiced non-surgical approaches are the Ponseti technique of serial manipulation and casting, and French taping. Ram's technique of taping is a truly conservative approach with a higher success rate to address this problem. Unlike French taping, it involves taping alternate days during the first week followed by twice in the second week, then once the following week, which is left in situ for a further two weeks. After the initial five weeks of taping, patients are provided with talipes splint for all time use, up till a year. This is followed by talipes shoes for walking and splint for nighttime use for another year. At the end of two years patients can wear normal shoes.

The study includes 225 patients with 385 clubfeet, who were treated with Ram's taping technique from September 1991 to August 2008. Inclusion criteria were age up to three months and previously untreated clubfeet. Average follow up was of 5.6 years. Outcome ratings at a minimum of two years were performed. Initial correction rate at the end of five weeks was 99%. A relapse of 21% was noted, two-third of which was salvaged via further taping and exercise, while remaining one third needed some form of surgical intervention. The comparative outcome for Ram's taping is better to Ponseti or French taping with good outcome in 93%, in comparison to 72% and 67% respectively.

To conclude Ram's taping is a fast, more effective, less cumbersome and fully conservative approach of correcting the clubfoot deformity.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIV | Pages 23 - 23
1 Jul 2012
Singh A Kent J Tourret L
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In order to achieve a true AP and lateral radiograph of the wrist, there must be no movement at the radio-ulnar joint. Projections taken with only pronation and supination at the wrist provide two views of the radius but a single view of the ulna. True radiographs are achieved by rotating the humerus through 90 degrees and extending at the elbow between the two views. Our aim was to look at whether true lateral and AP radiographs are taken by our radiology department.

Between April 2009 to November 2010, we identified all patients with ulna shortening osteotomies. This was because the plate and screws placed only in ulna making it easy to identify if two projections of the ulna have been achieved. Radiograph at first follow up were reviewed using PACS.

Of the 29 patients identified, 5 patients were excluded. Only 6 out of 24 patients had TRUE wrist projections

Most radiographs taken were inadequate and this has to be communicated with the radiology department. Two different views are needed to accurately comment on radiographs. Patients have to be sent back to radiology department. This causes an increase in clinic time, radiation to the patient and inconvenience.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_III | Pages 64 - 64
1 Feb 2012
Forward D Singh A Lawrence T Sithole J Davis T Oni J
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Background

It was hypothesised that preserving a layer of gliding tissue, the parietal layer of the ulnar bursa, between the contents of the carpal tunnel and the soft tissues incised during carpal tunnel surgery might reduce scar pain and improve grip strength and function following open carpal tunnel decompression.

Methods

Patients consented to randomisation to treatment with either preservation of the parietal layer of the ulnar bursa beneath the flexor retinaculum at the time of open carpal tunnel decompression (57 patients) or division of this gliding layer as part of a standard open carpal tunnel decompression (61 patients). Grip strength was measured, scar pain was rated and the validated Patient Evaluation Measure questionnaire was used to assess symptoms and disability pre-operatively and at eight to nine weeks following surgery in seventy-seven women and thirty-four men; the remaining seven patients were lost to follow-up.