Siddharth Jain

Infected wounds can be really hard to manage in cases of open fractures, chronic osteomyelitis, and superficial infection. When the skin is damaged, bacteria can quickly enter the underlying tissue and cause a potentially fatal infection. Regular wound dressing with antimicrobial agents has become available in vials as a way to decrease the chance of bacterial colonization and infection and speed up the healing of wounds. In this report, we discuss the shoelace suture technique and platelet-rich plasma (PRP) infiltration in the wound. Due to its ability to stimulate and fasten the healing of wounds, PRP is becoming more and more popular. The progressive suture approximation (the shoelace technique) is an easy and effective technique for gently approximating the skin borders. The cytokines and growth factors in PRP play a critical role in the healing process. Hence, the combination of these two techniques will reduce the need for hospitalization, lead to better aesthetic outcomes, and reduce healthcare costs.

Purpose The Judet’s technique of quadricepsplasty for an extension contracture of the knee joint offers the benefit of a sequential and controlled release of the intrinsic and extrinsic soft tissue constituents restricting the knee flexion. The main principle of our study was to analyze the clinical as well as functional outcome and to assess an extension lag following Judet’s quadricepsplasty for the knee extension contracture deformity. Materials and Methods This is a retrospective cohort study comprises of thirty three patients, operated for extension contracture with Judet’s quadricepsplasty with the mean follow-up was 30 months. Knee range of motion of the operated knee was recorded preoperatively and at 6, 12 and 24 month follow-up after the surgery. Judet’s criteria were used to evaluate the outcomes following the procedure. Results 92.42° (range, 60°–110°) of knee flexion was achieved after an average follow-up of 24 months compared to preoperative knee flexion was 14.09° (range 5°–25°), reflecting a 74.69° average improvement in knee flexion. Twelve patients had excellent results, nineteen had good results as per Judet’s criteria but there were no patients with extension lag. The two patients with fair results had superficial wound infection which healed without any further surgical intervention. Conclusions Judet’s quadricepsplasty offers sequential release without extension lag of the knee joint. Patients with the knee extension contractures deformity can be successfully managed with the Judet’s quadricepsplasty to gain useful knee motion and function.

Aims The purpose of this study was to analyze the clinical outcomes after Eden-Hybinette procedure for revision surgery in recurrent anterior shoulder instability in patients with epilepsy. Materials and Methods We retrospectively evaluated eight such patients between 2015 and 2018. Four patients had failed Latarjet/Bristow procedure and two had failed arthroscopic Bankart procedure, while two had history of both the procedures. After medical control of epilepsy, Eden-Hybinette procedure was performed in all patients. WOSI score and Rowe shoulder score was recorded preoperatively and in subsequent post-operative follow-up. A paired t test was used to analyze and compare preoperative and postoperative outcomes and was considered significant if p value was < 0.05. Results The average follow-up was 30 months (range 24–48 months). There was no recurrence of shoulder instability. The mean WOSI score before surgery was 77.3 (range 70–83), which improved to 24.2 (range 19–30) at 24-month follow-up. The mean Rowe score before surgery was 11.3 (range 5–15), which improved to 81.8(range 65–90) at 24-month follow-up. The improvement in WOSI and Rowe score was found to be statistically significant [p value < 0.05] Conclusions We conclude that Eden-Hybinette is a useful revision procedure to manage recurrent anterior shoulder dislocation in patients with epilepsy. Optimum medical control of seizure is also an important factor in preventing recurrent shoulder instability

Introduction: Chondromyxoid fibroma (CMF) is an uncommon benign tumor accounts for <2% of all benign and <1% all bone tumors. It is a cartilage tumor with myxoid and fibrous elements. Because of rarity and resemblance with other benign and malignant tumor, diagnosis of this tumor always remains challenging. Often, this lesion affects metaphysis of long growing bones of children and young adults. Common locations of this tumor are around the growth plate of proximal tibia and fibula and distal femur. Case Report: A 21-year-old male presented to orthopedic outpatient department with a history of the left hip pain for 1 year, following a trivial fall before 1 year. The patient was not able to do heavy strenuous activities such as running, jumping, and other sports activities. Terminal range of movements were painful. Magnetic resonance imaging suggested of cystic lesion involving synovial lining near head-and-neck junction of the left femur. Curettage of the lesion was done. The bone defect was not found to be large enough to be filled with bone graft. Histopathological examination showed lobular pattern with stellate to spindle-shaped cells on the myxoid background. Conclusion: CMF of subcapital region of femoral neck is an extremely unusual presentation. When occurring in middle-aged persons and in uncommon locations, this can raise suspicion of chondrosarcoma. Although intralesional curettage has the risk of recurrence in post-operative period, sufficient and careful curettage and excision of lesion will be enough to treat these benign lesions with good prognosis. Keywords: Chondromyxoid fibroma, intracapsular, benign tumor.

Aim Habitual dislocation of patella is an uncommon pathological condition. Though numerous techniques have been described in the literature for the treatment of patellar dislocations, none of the single procedure is fully effective in the surgical treatment of habitual dislocation of patella. We described our experience with a two in one procedure for habitual dislocation of patella in ten children. Patients and method Ten children having habitual dislocation were reviewed prospectively for twelve months following surgical procedure. The age ranged between 5 and 9 years. We performed graded lateral soft tissue release and patellar tendon transposition as described by Roux Goldthwait. Clinical results were evaluated using Kujala score, ability to do straight leg raise, knee range of motion and visual analogue scale. Result There has been no recurrence of dislocation. The mean Kujala score before surgery was 48 which improved to 97.8 at 12 months follow-up after the surgical procedure. At 12 months follow-up all patients were able to do straight leg raise and had almost full range of motion. Conclusion We conclude that extensive proximal lateral release along with Goldthwait Roux procedure helps in treating the habitual dislocation in patella in children. Decision for the extent of lateral release must be taken intra-operatively. Our method of treatment is simple, cost effective and reproducible with excellent functional outcome.

Repair of a “U” shaped rotator cuff tear tends to create extreme tensile forces at the central part of the rotator cuff margin, causing tensile overload and may result in subsequent failure. We describe our technique of repairing the “U” shaped tear in which margin convergence is done using Ethibond (Ethicon Inc., New Jersey) and a single triple-loaded suture anchor. It results in the reduction of the strain and also allows the repair of seemingly irreparable tears. We included 10 patients having a “U” shaped degenerative rotator cuff tear. All patients were assessed preoperatively. The University of California at Los Angeles Shoulder score (UCLA shoulder score) recorded preoperatively and at final follow-up was used to assess functional outcome. Out of 10 patients, six were males and four were females. The mean age was 60 years (range 50-70 years). The average follow-up was for 31 months (range 24 - 48 months). The UCLA score increased from an average of 9 preoperatively (range 8 - 12) to an average of 29.6 (range 27 - 31) at the terminal follow-up. The UCLA increased in the postoperative period and was statistically significant (unpaired t-test; p < 0.0001). All patients had good/excellent outcomes (UCLA score > 27). Abduction increased from average 27 degree preoperatively (range 20 degree - 35 degree) to an average 131 degree (range 125 degree - 140 degree) at final follow-up (unpaired t-test; p < 0.0001). Our technique of modified margin convergence achieves low tension repair and anatomical footprint reconstruction with good clinical outcomes using a single triple-loaded anchor.

Küntscher intramedullary nail (K-nail) proximal migration in the femoral medullary canal is a common postoperative complication. But spontaneous distal migration of the K-nail across the knee joint and protrusion over the tibia till the tibial tuberosity is a complication that has very rarely been reported in the literature previously. This is the case report of a 41-year-old man who presented with a pus discharging sinus over the tibial tuberosity for the last one year. K-nail insertion was done six years ago. The underlying cause of the migration of the K-nail is subject to controversy and speculation. Infection and delayed union with shortening are some etiological possibilities. Wrong selection of K-nail size, loosely fitted nail, premature weight-bearing, and disuse osteoporosis may also be contributory factors.

Introduction: Total knee arthroplasty (TKA) is a surgical procedure that provides pain relief and restores function for patients suffering from debilitating arthritis. Despite the overall success of the procedure, periprosthetic joint infection (PJI) is a rare but devastating complication andfound to be a major cause of TKA failure.An infected implant often requires removal, prolonged immobilization and antibiotic treatment and multistage surgery. Hence, prevention of infections in intraoperative and postoperative stage is of paramount importance. Material and method: We have conducted a retrospective study in SreeSudheendra Medical Mission hospital, Ernakulum, Kerala. We collected the data from April 2014 to March 2018. In this duration we have found 89 cases of rheumatoid arthritis underwent TKA in 148 knees. We have collected and analysed demographic data and information regarding risk factors [like ESR, H/O Diabeties, steroid intake, blood transfusion, preop deformity, preop DMARDs, intraop soft tissue manipulation/finding, Albumin Globulin ratio (A/G)] associate with infection. Postoperatively we have followed our patient for the minimum period of 9 months period to 4 years. Result: We identified DMARDs (esp. methotraxate) and intraoperative manipulation like bone grafting, extra soft tissue release, Z-plasty of tendon as a risk factor for superficial periprosthetic infection (P value 0.05). Conclusion: These results guide our understanding of the relationship between infections and TKA in RA patient, and may help to prospectively identifyinghigh-risk patients, facilitating extra vigilance and implementation of preventive strategies in such patients.

Introduction: Plantar fasciitis is the commonnest cause of heel pain. Its cause is uncertain so as there is a lot of treatment methods for it. Our study compares the outcome of two common treatment modaliy known as local infiltration of steroid injection and plantar fascia stretching exercises with each other regard to decrease pain intensity and improvement in function. Materials and methods: 80 patients with complain of heel pain clinicaly diagnosed as plantar fasciitis are included in the study. Other causes of heel pain are ruled out in them. One group with local steroid injection while the other group was treated with plantar fascia stretching exercises. They are re evaluated regard to function and pain scores after 2 and 10 weeks, Results: Two groups were similar regard to sex, age, height, weight and body mass index .Significant decrease in pain and improvement in function was reported in steroid group but, after the 10th week, two groups reported the same results in those manners. Discussion: It seems that because after 10 weeks of treatment with both therapeutic methods, the results were comparable , it is better to use the less complicated and less invasive method (stretching), but in cases which prompt pain relief and better function is desired, local steroid injection may be better.

Background: Stenosing tenosynovitis of fingers is one of the common tendinopathy attended in orthopaedic practice. A number of methods have been described for the treatment of this problem. Treatment ranges from conservative management to surgical procedures. Stenosing tenosynovit is also known as Trigger finger. Material & Methods: in this Prospective study all patients presented with trigger finger Grade 2 and 3 were randomly allocated into 2 groups. One group received local corticosteroid injection and in the other group, percutaneous release of pulley was performed as treatment option. These patients were then followed and assessed weekly over a period of two month and their progress noted. Results: We studied a total of 42 patients. Majority (71.4%) were females. The commonest age group is 40-50 years olds (56.6%).The most common presenting symptom was pain with triggering (52.3%). There was significant improvement in pain in the first two weeks in both groups but there was better improvement of pain in the corticosteroid group initially especially after first week. As for the triggering, there was significant improvement noted in first week in corticosteroid group but there was no difference in degree of improvement between both the groups after four week. The corticosteroid group had a complication rate of 10% whereas the percutaneous release group complication rate was 18.1%%. The recurrence rate was comparable in both the groups. Conclusion: Trigger finger is a common condition in orthopaedic practice. The commonly affected fingers are the centrally located on the palm. Local infiltration corticosteroid percutaneous release of pulley gives comparable results in long follow-up however corticosteroid injection gives better result initially with less complication.