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   Table of Contents - Current issue
July-December 2022
Volume 10 | Issue 2
Page Nos. 49-95

Online since Wednesday, February 22, 2023

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Posterior instrumented stabilization in the management of unstable thoracolumbar spine fractures with minimum 2 years follow-up p. 49
Pramod Nittur Kumaraswamy, Umesh Takhelmayum, Laishram Labango Singh, Dinendra Chirom, Ph Nickson Maku, Yogananda Mallanayakanakatte Lingaraju
BACKGROUND: Thoracolumbar region (T11–L2) involvement is most common among the spinal injuries often associated with catastrophic neurodeficits. There are many classification systems to describe thoracolumbar fractures, but few have been useful in recommending surgical decision. The treatment of thoracolumbar fracture has been debated extensively. Optimal surgical approach to be used to treat thoracolumbar fractures remains controversial. MATERIALS AND METHODS: Thirty-four patients with thoracolumbar injury classification and severity score ≥5, who underwent posterior instrumentation, were studied prospectively between August 2018 and July 2021. Follow-up assessment was done using x-ray, American Spinal Injury Association (ASIA) impairment scale, Denis pain and work scale, and Oswestry disability index. RESULTS: Most of the patients were belonged to age group 31–40 years (44.1%, n = 15); L1 was the most common vertebra injured (61.8%, n = 21). Average kyphosis correction obtained by surgery was 10.53°, and the average loss of kyphosis correction at 2 years was 2.94°. Surgery duration and blood loss when compared between short-segment fixation (SSF) and long-segment fixation (LSF) showed a statistical significance (P < 0.0001). Associated injuries were seen in 11.76% (n = 4) of patients. At final follow-up, 85.71% (n = 24) of patients showed improvement to one higher ASIA grade; 82.4% (n = 28) of patients reported to have no pain or occasional minimal pain. CONCLUSIONS: Posterior pedicle screw-rod fixation is relatively safe, more familiar, and associated with less morbidity. Most of the fractures can be treated by SSF, but in patients with severe vertebral body comminution (AOtype A3) and AO type C fractures, LSF can be done.
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MRI and functional assessment of triportal technique in arthroscopic anatomical single-bundle anterior cruciate ligament reconstruction p. 56
Sharat Balemane, Nishanth Shetty, Airody Chandrashekar Ramu, Abdul Rahman
BACKGROUND: Arthroscopic anterior cruciate ligament (ACL) reconstruction surgery is routinely performed using two standard portals; however imprecise portal placement leads to the most common surgical error that is associated with the imprecise placement, which is the non anatomical positioning anatomical positioning of the femoral tunnel because of improper visualization of the posterior aspect of the medial surface of lateral femoral condyle, due to inadequate visualization of the attachment area over the femur using the standard two portals. To decrease the incidence of this error, various other portals have been descried to improve the visualization. We propose the routine use of an accessory medial portal, in addition to the standard anterolateral and anteromedial portals, to enhance the visualization of the lateral wall and to improve the anatomic accuracy. The arthroscope can also be moved interchangeably throughout the portals during the procedure for improved viewing during specific steps. The routine use of this portal was assessed both clinically and radiologically in our study at the end of 1 year by functional scoring and magnetic resonance imaging (MRI) scan, wherein the accuracy of the femoral attachment and healing of the graft were checked. OBJECTIVES: To assess the functional and radiological results of the routine use of triportal technique in anatomical ACL reconstruction. MATERIALS AND METHODS: We conducted a prospective study on 20 patients who were assessed preoperatively and postoperatively at the end of 12 months using the International Knee Documentation Committee and Lysholm score, and the stability was checked with Lachman and pivot shift test. An MRI of the postoperative knee was performed after 12 months to assess the position of the graft, graft integrity, and healing. RESULTS: All the patients at the end of the study had an exceptional functional and clinical outcome,which was correlated on MRI showing a near-accurate placement of the femoral tunnel with acceptable inclination. All our patients showed excellent anteroposterior and rotational stability when assessed by IKDC and Lysholm score at the end of 1-year follow-up. CONCLUSION: This study shows that the routine use of the accessory anteromedial portal gives a good functional outcome with the near-accurate placement of femoral tunnel, which corresponds to the MRI findings obtained in our study.
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Changes in sagittal spinal alignment and pelvic parameters in patients undergoing a total hip arthroplasty p. 63
Yoji Ogura, John R Dimar, Mladen Djurasovic, Steven D Glassman, Leah Y Carreon
BACKGROUND: The relationship of the spine to the pelvis has been widely studied. However, the role of the hip joint in maintaining sagittal balance remains poorly understood. We aimed to examine if radiographic sagittal spine and pelvic parameters change after Total Hip Arthroplasty (THA), and to evaluate the postural effects on these parameters in standing, sitting, and supine positions. MATERIALS AND METHODS: 36-inch anteroposterior and lateral standing, sitting and supine radiographs in patients undergoing a unilateral THA pre and post THA were obtained. Standard pelvic and spinal alignment parameters were measured. RESULTS: There were 31 cases with complete radiographic information. Pre-THA SVA was 35.7mm, improving to 24.9mm post-THA. Lumbar lordosis was 50.6° standing and 33.8° sitting; maintained post-THA at 50.6° standing and 36.4°sitting. Pelvic incidence remained unchanged in all positions pre and post-THA (49.1° to 51.2°). Pre-THA sacral slope was 36.9° standing, 23.3° sitting and 40.9° supine. This was maintained post-THA (36.0° standing, 22.9°sitting and 39.7°supine). Pre-THA pelvic tilt was 14.5° standing, 27.8° sitting and 8.8° supine. This was maintained post-THA (15.3° standing, 28.2°sitting and 12.0°supine). Lumbar lordosis was significantly less, and pelvic tilt was significantly greater in sitting position than in standing and supine positions, representing the pelvis moves posteriorly as a patient goes to a seated position,CONCLUSION: This study establishes baseline values for the normal standing, sitting and supine sagittal spine and pelvic parameters patient’s undergoing THA. THA does not seem to lead to substantial changes in sagittal spine and pelvic radiographic parameters.
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Effect of body mass index on the conventional method of templating in uncemented total hip arthroplasty: A prospective study p. 69
Akshay Sharma, Kamparsh Thakur, Manish Prasad, Varun Vig
BACKGROUND: Preoperative templating is an important step in total hip arthroplasty (THA). Results of traditional as well as digital method of templating are well established in various studies. Very few studies have evaluated the effect of body mass index (BMI) and gender on templating. Our study was undertaken to evaluate the effect of BMI and gender in accurate size estimation in uncemented THA components by conventional method of templating. MATERIALS AND METHODS: Preoperative radiographs were templated for 60 patients who underwent primary uncemented THA. BMI and gender of patients were noted during preoperative evaluation. Patients were grouped as per gender and divided into three groups as per BMI (underweight <18.5, normal 18.5-24.9, overweight >25). The estimated preoperative template size was compared with the actual implant size used. P-value of <0.05 was considered to be significant. RESULTS: Acetabular component was exactly templated in 63.33% and femoral component in 76.6% cases. Gender and BMI had no statistical difference in component size prediction. Post-operative analysis of THA performed showed statistically significant association between high BMI and limb length discrepancy and restoration of femoral offset. CONCLUSION: In our study, we found that femoral component is more accurately predicted. No statistically significant effect of gender and BMI was seen in accuracy of conventional method of templating in implant size estimation. However, BMI is found to affect limb length assessment during surgery and restoration of femoral offset.
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Arthroscopic reconstruction of anterior cruciate ligament: 4-strand versus 5-strand hamstring autograft p. 73
Chetan Goyal, Surinder Singh Ajrawat, Joseph J B Mal, Bhuwan Sharma
INTRODUCTION: In present study, we aimed to compare the functional outcome after 4-strand versus 5-strand hamstring autograft for anterior crucial ligament reconstruction using Tegner Lysholm score. MATERIALS AND METHODS: Study included 70 cases (35 in each group) of complete anterior cruciate ligament tear confirmed radiologically on MRI. After doing anterior cruciate ligament reconstruction with 4- and 5-strand hamstrings autograft, the patients were assessed for the functional outcome using Tegner Lysholm score at post-operative interval of 3, 6 and 9 months. Data were analyzed using SPSS software version 21. RESULTS: Tegner Lysholm score at baseline was 41.63 and 42.01 in 4- and 5-strand group which increased progressively to 93.45 and 85.13 at the end of 9 months. The improvement was significantly more in 5-strand group (P < 0.05). Overall, at the end of follow-up, excellent results were seen in 71.4% versus 60% patients while good to fair results were seen in 20% versus 28.6% and 8.6% versus 8.6% patients in 4- and 5-strand groups, respectively. Poor outcome in terms of revision surgery was required in one case (2.9%) of 4-strand group. CONCLUSION: Study concluded that single 5-strand graft offers good functional outcome in cases of anterior crucial ligament reconstruction. A 5-strand hamstring graft provides an increase in diameter than 4-strand graft, which leads to stronger graft and reduced revision rate. It is especially useful in the cases of undersized hamstring graft or stability issues.
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Functional outcome of intra-articular platelet-rich plasma in periarthritis shoulder p. 78
Ajay Kurahatti, Arun H S , Hariprasad S , Nagakumar J S
BACKGROUND: The annual incidence of periarthritis shoulder is between 3% and 5% among general population and as high as 20% among individuals with diabetes. A variety of treatment modalities have been advised but best modality of treatment is subjected to debate. Intra-articular injection of platelet-rich plasma (PRP) is an emerging treatment option and its efficacy needs to be examined and hence the study was conducted. MATERIALS AND METHODS: This prospective analytical study on 46 cases with frozen shoulder was conducted in the Department of Orthopedics, R L Jalappa Hospital, Kolar. The patients were injected intraarticularly with PRP with posterior approach. Patients were assessed at 3, 6, and 12 weeks. Outcome measures, visual analog scale (VAS) score for pain, and QuickDASH for functional ability were measured. RESULTS: Of 46 patients, 21 were men and 25 were women. Mean age of patients was 51 years. Nondominant shoulder was affected in 27 and dominant shoulder in 19 patients. Eleven patients had diabetes mellitus. Mean active abduction improved from the baseline of 65.1° to 133.04°, mean active flexion improved from 82.6° to 147.28°, mean active external rotation improved from 25.3° to 70.02°, and mean active internal rotation improved from 18.91° to 68.58° at the end of 6 weeks’ follow-up. VAS score improved from 6.19 to 1.84 at 12 weeks post-procedure. Functional ability assessed with QuickDASH score showed improvement with successive follow-ups from 81.5 to 22.9. Approximately 52.2% of study patients had excellent results, and 43.5% and 4.3% of patients had good and fair results, respectively. CONCLUSION: In this study, single injection of PRP resulted in significant improvement in range of motion of shoulder, pain, and function with long-term effects. Under total aseptic precautions, when performed with a right technique it has no side effects. This study observes that PRP injection is a reliable, productive, efficient, and safe mode of treatment in periarthritis of shoulder.
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A study of association between acromion types and shoulder pathology p. 92
Sagar Venkataraman, Prabhu Ethiraj, Arun Heddur Shanthappa, Kishore Vellingiri
INTRODUCTION: Shoulder impingement and rotator cuff tear are commonly seen in shoulder pathology. Pathological changes in the soft tissue around the shoulder can be due to intrinsic degenerative in tendons or extrinsic mechanical compression due to acromion types. Changes in acromion morphology have been postulated, which might be one of the causes of impingement syndrome and rotator cuff tears. But few study results have shown that role of the acromion is doubtful. Our primary objective was to determine acromion types and their prevalence rate with shoulder pathology. MATERIALS AND METHODS: Our study was a prospective study. Eighty-five patients who met the inclusion criteria were included in the study. According to Bigliani et al., acromion types were classified as type 1 acromion that has a flat undersurface, type 2 acromion that has a curved undersurface, and type 3 acromion that has a hooked undersurface on supraspinatous outlet view radiographs. Types of acromion were correlated with shoulder pathology (shoulder impingement and rotator cuff tear). RESULTS: Out of 85 patients with shoulder pathology, 43 patients had impingement shoulder syndrome and 42 patients had rotator cuff tear. Mean age for the impingement shoulder syndrome group was 39.6 years and for the rotator cuff tear group it was 58.6 years. Overall right shoulder is affected more as compared with the left shoulder. Type 2 acromion was seen in 64.7% study population, type 1 was seen in 23.5%, and type 3 was seen in 11.8%. CONCLUSION: In our study, type 2 acromion is more frequently seen in shoulder pathology involving rotator cuff tear and impingement syndrome.
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