Department Of Orthopaedic Surgery Research Articles

Preoperative vs. Postoperative Functional and Pain Status in Arthroscopic ACL Reconstruction Using Quadriceps Tendon

Introduction: Anterior cruciate ligament (ACL) injuries significantly impact mobility and overall quality of life, necessitating prompt and effective intervention. The purpose of this study was to assess preoperative versus postoperative functional and pain status in arthroscopic ACL reconstruction using the quadriceps tendon. Aim of the study: The aim of the study was to evaluate preoperative versus postoperative functional and pain status in arthroscopic ACL reconstruction using the quadriceps tendon. Methods: This prospective interventional study was conducted in the Department of Orthopaedic Surgery at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from March 2020 to August 2022, enrolling 30 patients with isolated anterior cruciate ligament (ACL) injuries. Informed consent was obtained, and diagnoses were established through X-rays and MRI. Outcome measures were evaluated using the Lysholm score, Tegner score, and Visual Analogue Scale (VAS) at follow-up intervals, with statistical analysis conducted using SPSS version 26.0. Result: The study of 30 patients (mean age 29.73 ± 7.00 years, 90% male) found significant improvements post-surgery: Lysholm scores rose from 48.57 to 89.63, Tegner scores from 3.03 to 7.10, and VAS pain scores dropped from 0.90 to 0.20 (all p < 0.001). Conclusion: Arthroscopic ACL reconstruction using the quadriceps tendon led to significant improvements in knee function, enhanced activity levels, and reduced pain, demonstrating its effectiveness in restoring pre-injury status.

Comparing scissors and scalpels to a novel surgical instrument: a biomechanical sectioning study

BackgroundThis study introduces a novel surgical instrument to reduce iatrogenic nerve injuries during procedures such as carpal tunnel and ulnar nerve decompression surgery. These injuries often result from direct damage to surrounding tissues by surgical instruments, whose designs have remained largely unchanged over the past decades. The novel device is a modified surgical forceps that has a deployable surgical scalpel that runs along a groove on the forceps. This design protects important anatomical structures while allowing fast dissection and cutting of fascial layers.MethodsThe process used to develop a novel instrument included computer-aided design (CAD) modeling, 3D printing for prototyping, and the fabrication of an aluminum prototype. Biomechanical testing was performed with the novel device, iris scissors, bandage scissors, and a scalpel on an MTS Static Materials Test System. The peak force to slide-cut, number of cut attempts, and percentage cut on first attempt were compared between the prototype and traditional surgical tools. The materials cut in testing were Ace™ bandage, stockinette, and gauze. Statistical analyses were performed using Welch’s t-tests and Fisher’s exact tests.ResultsCompared to conventional bandage and iris scissors, the novel surgical instrument required significantly less force to cut through an Ace™ bandage, stockinette, and gauze (p < 0.01). The number of cuts required to transect those same materials with the novel device was comparable to that of the scalpel and bandage scissors. Additionally, while there were no differences between the novel device and the other devices for an Ace™ bandage and stockinette, the novel device tended to cut a greater percentage of gauze in one pass than did the iris scissors.ConclusionThe novel surgical instrument designed in this study required less force compared to conventional scissors, demonstrated cutting efficiency similar to that of a scalpel blade, and had more safety features than either instrument. This study highlights the value of collaboration between biomedical engineering and orthopedic surgery departments on innovation in medical technology, through which new technologies with improved design and functionality demonstrate the potential to reduce iatrogenic injuries.

Initial response to the 2024 Noto earthquake by the university hospital closest to the disaster area

Major earthquakes have occurred frequently in Japan throughout history, and the 2024 Noto earthquake is no exception. However, such natural disasters differ in some respects, and specific problems related to these events have also become clear. Kanazawa Medical University Hospital, which was the closest university hospital to the disaster area of the 2024 Noto earthquake, played a crucial role in serving the local community in the wake of the earthquake. The first method used to identify disaster-related patients is to tag them when they are examined by a physician. After confirming that a patient was eligible at the disaster-related patient-determination meeting, patients’ medical information was extracted from the tag name. A total of 421 disaster-related patients were transported and hospitalized by day 31. Fifty-two (14.4%) and 48 (13.3%) patients were admitted for orthopedic surgery and respiratory medicine, respectively. Forty (11.1%) and 38 (10.5%) patients were admitted to cardiology and nephrology departments, respectively. These four departments account for 49.3% of the total. The number of hospitalized patients in the nephrology and orthopedic surgery departments was high immediately after the 2024 Noto Earthquake. We also describe new hospital-specific initiatives and recommendations to improve Kanazawa Medical University Hospital’s system while sharing another hospital experience.

Comparison of the Effectiveness of Autologous Blood Injection and Steroid Injection in Managing Tennis Elbow.

Background Local depot steroid injections can consistently and predictably relieve tennis elbow pain in the short term. Prolotherapy, extracorporeal shockwave therapy, autologous blood, and local injections of platelet-rich plasma (PRP) are examples of novel treatment approaches. Objective The objective of this study is to compare the effectiveness of autologous blood injection and local steroid injection in providing pain relief for patients with lateral epicondylitis (tennis elbow)using the visual analog scale (VAS) over 12 weeks. Methods A descriptive case series was conducted from July 10, 2019, to July 9, 2021, at the Department of Orthopaedic and Spine Surgery, Ghurki Trust Teaching Hospital. A total of 396 patients with tennis elbow, aged 20 to 50 years, were included (198 in each group). Patients managed with non-operative methods and those with other associated injuries in the same elbow were excluded. Group I received an injection of 40 mg of methylprednisolone acetate with 1 ml of 2% lignocaine solution. Group II received an injection of 2 ml of autologous venous blood. The final outcome was assessed at 12 weeks. Results In Group I, the average age of the patients was 36.04 ± 8.26 years, while in Group II, it was 37.23 ± 7.32 years. The male-to-female ratio was2.3:1; 276 (69.81%) of the 396 patients were male, while 120 (30.19%) were female. Group I's mean baseline VASscore was 6.99 ± 0.99, while Group II's mean baseline VAS score was 6.99 ± 1.06 (p = 1.000). Group I had a mean post-therapy VAS score of 3.11 ± 1.62, while Group II had a mean score of 2.48 ± 1.26 (p = 0.0001). About 118 (59.60%) individuals in Group I and 156 (78.79%) patients in Group II experienced pain alleviation from lateral epicondylitis (p = 0.0001). Conclusion This study found that autologous blood injection significantly reduces pain in patients with lateral epicondylitis compared to steroid injection, with a statistically significant p-value of 0.0001. Pain relief was more frequent in the autologous blood group (78.79%) than in the steroid group (59.60%). These findings suggest that autologous blood injections may offer a more effectivetreatment, reducing the need for repeat procedures and improving patient outcomes.

Role of blood urea nitrogen to creatinine ratio in the assessment of hypovolemia who have undergone major surgeries- a cross-sectional study

BackgroundMajor surgeries are being carried for certain ailments. Surgeries can be major or minor depending on the extent of intervention. Major surgeries are prone to cause lots of complications such as shock, haemorrhage, wound infection, deep vein thrombosis, pulmonary complications, organ rejection, reactions to anaesthetics etc. Early identification of complications could reduce morbidity and mortality. Laboratory variables used in the assessment of hypovolemia include blood urea nitrogen, sodium, osmolality, hematocrit, and arterial blood gas. This study was undertaken to assess the utility of blood urea nitrogen: creatinine ratio (BCR) in the utility of assessment of hypovolemia in the first post-operative day in individuals who had major surgeries.Methods and materialsThe retrospective cross-sectional study included participants from the Departments of Orthopedic Surgery, Obstetrics and Gynecology, General Surgery and Cardiothoracic Surgery. Patients who underwent major surgeries between January 2019 and January 2020 were included. Study participants of 30 to 60 years of both genders were recruited into the study. Data were collected from the Medical Records of a tertiary care hospital in Chennai, India. Ethics approval was obtained, the institutional ethics committee (Ref: CSP/21/SEP/99/479 dated 30–12-2021). Waiver of consent was obtained since the patients were treated and discharged from the hospital. The data were analyzed by SPSS version 16. P value ≤ 0.05 was taken to be significant.ResultsBCR showed statistically significant difference across the groups with P = 0.02. BCR showed statistically significant difference between cardiac patients with total knee replacement and total abdominal hysterectomy surgeries. BCR showed positive correlation with age, fluids intake and negative correlation with pulse rate and respiratory rate.ConclusionBCR is a simple diagnostic tool for identifying hypovolemia in individuals who undergo major surgeries especially in the first postoperative day. It is significantly altered across the groups with highest value in individuals who have undergone knee replacement surgeries. BCR has high specificity and positive predictive value.

Organisms Causing Postoperative Implant Infection in Orthopedic Patients Presenting at a Tertiary Care Hospital.

Introduction Infections pose a significant challenge in orthopedics related to implant failure. In orthopedic surgeries, surgical site infections (SSIs) extend the patient's hospital stay by an average of two weeks and also increase morbidity, double hospitalization rates, and triple the financial burden on the patient. This study aims to determine the common organism in patients with postoperative implant infections presenting at a tertiary care hospital. Methods A cross-sectional study was conducted in the Department of Orthopedic Surgery at JPMC Karachi over a six-month period, from November 24, 2022, to May 25, 2023. All patients of both genders aged 18-65 years presenting with postoperative implant infection within six hours of the development of symptoms were enrolled. Baseline demographic details and clinical histories were recorded at the time of presentation. A swab for culture and sensitivity was taken from the implant site using a sterile swab stick in patients with confirmed or suspected infections. Results Of 196 patients, the mean age of the patients was 48.47±5.19 years. Gender distribution showed that 49% of patients were females and 51% were males. The mean duration of surgery was 1.71±0.49 hours (100 minutes approximately);Klebsiella species 26% and Staphylococcus aureus25.5% were the most common organisms isolated from infected surgical wounds, followed by Pseudomonas species in 32 patients (16.3%), Acinetobacter species in 27 patients (13.8%), Escherichia Coliin 23 patients (11.7%), and coagulase-negativeStaphylococcusin 13 patients (6.6%). Conclusion In our cohort, Staphylococcus species and Klebsiella species were the most common pathogens isolated from postoperative implant infections. The rise in Klebsiella species suggests that changes in prophylactic antibiotic practices may have contributed to this trend. Therefore, there is an urgent need to reassess current prophylactic strategies in light of the increasing incidence of infections caused by gram-negative bacteria.

Exploring Impact and Variability of Research Productivity Among Academic Orthopaedic Leaders.

Assessing scholarly contributions in academic orthopaedic surgery remains challenging, despite the importance of publication productivity in evaluating academic leaders. The Hirsch (h)-index and its derivative, the m-index, offer objective measures to compare and evaluate publication productivity. The primary aims of this study were to compare h- and m-indices of department chairs and residency program directors of orthopaedic training programs in the United States and assess the association between h-index and program rank. A publicly available Doximity report was used to identify and rank orthopaedic surgery residency programs in the United States. Internet-based searches of institution-specific websites were performed to confirm current department chairs and residency program directors as of January 2024. H-index data were collected from a publicly available database known as Scopus. The m-index was calculated as the quotient of h-index and years in practice. Gender and years in practice were obtained through available biographies on institution-specific websites. Department chairs had significantly higher h- and m-indices at both the career and 5-year time intervals compared with program directors. Upon subgroup analysis, department chairs and program directors at top-10 ranked programs had significantly higher h- and m-indices compared with the entire population of department chairs and program directors. Linear regression analyses demonstrated a direct linear association between department chair/program director h- and m-indices and program rank. Publication productivity was higher for department chairs than residency program directors. Orthopaedic leaders at top-10 institutions had higher publication productivity compared with those at institutions outside of the top 10, per Doximity rankings. Finally, there is substantial variation in publication productivity of orthopaedic surgeons in leadership roles at academic institutions in the United States. This study highlights the publication productivity of orthopaedic surgery department chairs and residency program directors and describes the linear association between publication productivity of academic orthopaedic leaders and program rank. This information can be utilized by those interested in learning more about the publication productivity among academic orthopaedic surgeons across different institutions and can assist those who are involved in the hiring and promotion process at these academic institutions.

Management of cubitus varus deformity by three-dimensional osteotomy: analysis of outcome

Background: Cubitus varus deformity, commonly resulting from malunited supracondylar fractures of the humerus, is prevalent in pediatric and adolescent populations. Traditional treatment methods often fall short in addressing the complex three-dimensional nature of this deformity. This study aims to evaluate the efficacy and outcomes of three-dimensional osteotomy in correcting cubitus varus deformity. Methods: This prospective interventional study was conducted at the Department of Orthopaedic Surgery, BSMMU, Shahbag, Dhaka, from March 2016 to September 2018. A total of 40 patients aged 8 to 20 years with cubitus varus deformity were enrolled. Participants underwent three-dimensional osteotomy, and outcomes were assessed using the Mayo Elbow Performance Score (MEPS) and functional recovery parameters. Results: The majority of patients (75%) achieved bone union within 8-10 weeks post-osteotomy. The MEPS results were promising, with 40% of patients scoring 'Excellent' and 45% scoring 'Good'. Functional outcomes were predominantly positive, with 95% of patients reporting satisfactory results. The complication rate was low, with 80% of patients experiencing no postoperative complications. Conclusions: Three-dimensional osteotomy is an effective and reliable surgical intervention for treating cubitus varus deformity, offering high rates of patient satisfaction, minimal complications, and improved functional outcomes. This technique presents a promising option for orthopedic surgeons in managing this complex deformity.

The comprehensive value of the modern vascular surgeon to the orthopedic surgery service

ObjectiveOrthopedic surgery is among the highest compensated specialties in modern practice. Vascular surgeons are consulted frequently during orthopedic operations, however, the comprehensive value of the vascular surgery service to the safe delivery of orthopedic care has not been characterized previously. MethodsElectronic medical records were retrospectively queried for all operations performed by orthopedic surgeons requiring operative vascular surgical consultation from June 2013 to December 2023. Data were collected on case-specific details, reasons for consultation, and total charges. Work relative value units were calculated for each primary orthopedic procedure using the Centers for Medicare and Medicaid Services physician fee schedule. ResultsA total of 952 operative vascular surgery consultations were required over the study period. Consults were requested by 56 orthopedic surgeons across all eight orthopedic subspecialties at our institution. Operative vascular consultation was requested across 108 different procedure types. A total of 94 consults (9.9%) were emergent, intraoperative requests, with the remaining 858 consults (90.1%) occurring in the preoperative setting. The most common causes for consultation included surgical exposure (n = 832 [87.4%]), inadvertent bleeding (n = 44 [4.6%]), need for bypass (n = 12 [1.3%]), and acute limb ischemia (n = 11 [1.2%]). Total charges for all operative consultations exceeded $91.5 million, and the calculated total work relative value units for all primary orthopedic procedures was 19,384.5. A total of 54 cases (5.7%) occurred after hours, on a weekend, or both. ConclusionsVascular surgeons are integral to the provision of orthopedic surgical services, inclusive of all orthopedic subspecialties, for both the prevention and treatment of iatrogenic vascular injury. The around-the-clock availability of a vascular surgeon enables the orthopedic surgery department to generate significant revenue for the hospital system. These findings are important to the ongoing discussions regarding the value and compensation of the modern vascular surgeon.

The Role of Early Mobilization in Outcome of Proximal Tibia Fractures Treated with Dual Plating

The management of bicondylar fracture of the proximal tibia is a challenging task and the aim of management is to achieve stable, painless and mobile joint and also to prevent the secondary degeneration of the joint. Open reduction and internal fixation with dual plating in such fractures is beneficial to address fracture fragments in different planes and also to achieve anatomical reduction under direct vision. It also allows stabilizing the fracture which helps in early mobilization of the patient. Early post-op rehabilitation is one the most important factor that play a vital role in outcome of the operated knees by preventing the post- operative stiffness and achieving good range of motion. This is a retrospective study conducted in Department of Orthopedic Surgery, Kurmitola General Hospital, Dhaka, Bangladesh from July to December 2022. Total 100 patients were included in the study. The functional outcome was evaluated according to Rasmussen scoring system. Mal-reduction of the articular surface was defined as an intra- articular step-off of at least 2 mm measured on scaled radiographs. Oldest patient was 71 years and youngest patient was 20 years old. Male were 79% and female were 21%. All the patients with bicondylar fracture treated with dual plating. Data was obtained from the Medical record department, indoor ward records, OPD registers and Operation theatre records. This study analyses the outcome of bicondylar proximal tibia fracture treated with dual plating in 100 patients. In our series we found 63 % excellent results and 28 % good results, while 7 % and 2% fair and poor outcome respectively. Fractures of proximal tibia are increasing with the increase in mechanization and increased road traffic in current world today. These fractures are more in men and those who use automobiles frequently for their outdoor ventures. Better preoperative planning in selection of approach can minimize the soft tissue injury and unnecessary periosteal stripping. ......

Assessing Functional Outcome of PHILOS Plate Fixation in Proximal Humerus Fractures- A Prospective Study

Introduction: Despite the availability of numerous treatment options, managing unstable proximal humeral fractures remains a significant surgical challenge. Utilizing a PHILOS plate is an effective surgical technique for addressing these fractures. This approach provides stability and support to the fracture site, promoting proper healing and potentially improving patient outcomes. Aim of the study: The aim of this study was to assess the functional outcome of PHILOS plate fixation in proximal humerus fractures. Methods: This prospective study was conducted in the the Department of Orthopedic Surgery, National Institute of Traumatology and Orthopedic Rehabilitation (NITOR), Sher-e-Bangla Nagar, Dhaka, Bangladesh during the period from January 2009 to December 2010. A total of 80 patients aged over 18 years were included in the study. Patients with open, pathological and ipsilateral distal fractures in the same limb were excluded from the study. Result: The youngest and the oldest one were 23 and 78 years respectively. Majority of the patients were male and business was their main occupation. Fifty patients (62.5%) presented with 3-part fractures, ten (12.5%) with four-part fractures and twenty (25%) with fracture dislocation. The interval between injury and plate fixation was 18 days and minimum and maximum interval was 2 and 78 days respectively. Majority (92.5%) of the injury was caused by high-velocity accident. Evaluation of the outcome at 6 months showed that 62.5 percent of patients had good outcome, 25 percent patients had fair outcome. Conclusion: PHILOS plate fixation for proximal humeral fractures provides stable fixation and good functional outcomes, particularly in elderly patients.

Genetic Analysis of Potential Biomarkers and Therapeutic Targets in Ferroptosis from Steroid-Induced Osteonecrosis of the Femoral Head Based on Machine Learning.

To locate the candidate therapeutic target genes involved in ferroptosis in steroid-induced osteonecrosis of the femoral head (SONFH). Bioinformatics analysis study. Place and Duration of the Study: Department of Orthopaedic Surgery, Zhuhai Hospital of Integrated Traditional Chinese and Western Medicine, Guangdong, China, from March to July 2023. After processing the gene expression omnibus (GEO) data with the R programming language, differentially expressed ferroptosis-related genes in SONFH were identified. To pinpoint the genes most strongly linked to SONFH in association with ferroptosis, least absolute shrinkage and selection operator (LASSO) regression and support vector machine-recursive feature elimination (SVM-RFE) were employed. Subsequently, the screened essential genes were analysed to investigate immune cell infiltration, and competing endogenous RNA (ceRNA) networks involving these marker genes were constructed. The machine learning algorithms identified three genes i.e., SOCS1 (suppressor of cytokine signalling1), MYCN (N-myc proto-oncogene protein), and KLF2 (Kruppel-like factor 2) as diagnostic feature biomarkers associated with ferroptosis. Additionally, CIBERSORT analysis revealed that alterations in the immune microenvironment, such as Macrophages M1, Monocytes, and T cells CD4 naive, could be linked to SOCS1, MYCN, and KLF2. Moreover, the competing endogenous RNA (ceRNA) network exposed a complex regulatory relationship based on marker genes. SOCS1, MYCN, and KLF2 are potential biomarkers associated with ferroptosis in SONFH, pending confirmation in future studies. Steroid-induced osteonecrosis of the femoral head, Ferroptosis, Machine learning, Genetic analysis.

Dimension of normal anterior cruciate ligament on MRI in our population.

Objective: The present study will help us in establishing local statistics in our population. Study Design: Descriptive study. Setting: Department of Orthopedic Surgery at Khyber Teaching Hospital in Peshawar. Period: June 2023 to December 2023. Methods: Seventy MRI of knee were collected. Knee MR images sagittal and coronal plane (T2-Weighted Images) were reviewed by radiologist and only knees with an intact cruciate ligament were included in the study. All the measurement (length and width) were made with electronic caliper. Results: Regarding radiological length of ACL on sagittal view on MRI, the minimum length was 28mm and maximum was 46mm and mean length was 34mm and standard deviation of 4.49, Regarding width of ACL on sagittal view it was found that the minimum length was 8mm and maximum was 16mm and its mean length was 10.4mm with standard deviation of 2.02. While the width of ACL on coronal plane was such that the minimum length was 6mm maximum was 16mm its mean was 11.34 and standard deviation of 2.48. By applying one sample T-Test and compare with Kowen parameter the p value was 0.00 for both length and width showing statistically highly significant. Conclusion: In conclusion in our population ACL is shorter and thicker then westerns population. Further studies should be done arthroscopically and on cadaveric to establish our local statistics of anthropometric measurements of anterior cruciate ligament.

Accessibility and Characterization of Parental Leave Policies for Orthopaedic Surgery Residency Training in the United States.

This study assesses the accessibility and nature of parental leave policies during orthopaedic surgery residency training after implementation of the Accreditation Council for Graduate Medical Education (GME) mandate for 6 weeks of paid parental leave effective July of 2022. An audit of orthopaedic surgery residency and affiliated GME websites was conducted to assess the accessibility of parental leave policies during the 2023-2024 academic year. Details on length of leave and nature of renumeration during the leave were recorded. Bivariate analyses were conducted to determine residency program characteristics associated with the accessibility of a parental leave policy. Results were compared with a previous analysis during the 2017-2018 academic year. A total of 200 residency programs were evaluated, and 152 had parental leave policies (76.0%). Compared with 2017 to 2018, a similar percentage of parental leave policies were accessible on residency program websites (3.0% vs. 2.0%, P = 0.777) but fewer were accessible on GME websites (55.5% vs. 80.7%, P < 0.001). More contemporary policies were obtained from program coordinators (18.5% vs. 7.2%, P = 0.003), and more were not available (24.0% vs. 9.0%, P < 0.001). Most policies offered renumeration (86.7%) and leave for 6 weeks in length (75.0%). A higher prevalence of parental leave policy accessibility was found among orthopaedic residency programs with university affiliation (P < 0.001), more faculty members (P = 0.008) and residents (P = 0.017), a higher percentage of female faculty (P = 0.008), affiliation with a top 50 ranked National Institutes of Health-funded orthopaedic surgery department, and accreditation achieved before 2017 to 2018 (P = 0.004). Most orthopaedic surgery residency programs do not have accessible parental leave policies on their websites. The new Accreditation Council for GME mandate will require orthopaedic residency programs to provide residents with 6 weeks of paid parental leave during residency training. Accessible policies may be useful to applicants interested in child rearing during orthopaedic residency training.

Study on Fixation Methods for Metacarpal Bone Fracture

Introduction with Objective: The aim of the present study was to assess the fixation methods for metacarpal bone fracture. Materials and Methods: A prospective observational study was conducted from February 2019 to January 2020 among 29 metacarpal bone fracture patients attending at orthopedic surgery department, Chittagong Medical College Hospital, Chittagong after obtaining requisite consent from the patient. Data were collected through the assessment and X-ray report of patients in the orthopedic surgery Department. The collected data were entered into the computer and analyzed by using SPSS (version 20.1) to assess the fixation methods for metacarpal bone fracture. Results: Most of the study population (89.7%) was in 18-40 years of age group. The mean age of the patients was 33.14 ± 11.895 years (range: 18-70 years). Service was the mostly occurring occupation among the patients (35%) and worker were 31%. In our study transverse fracture was 51.7% and oblique fracture was 41.4%. In case of method of fixation, maximum (65.5%) patient’s fixations were done by mini plate, 31% were by K-wire and 3.4% were by both K-wire &amp; lag screw. In case of number of metacarpal bone involvement, 1 bone was involved in maximum (75.9%), 2 bone were involved in 17.2% and 3 bone were involved in 6.9% patients. Conclusion: Closed or minimally invasive fixation with K-wire, mini plates and screws are safe methods and can be performed with minimal complications. Maximum (65.5%) patient’s fixations were done by mini plate. Medicine Today 2024, Vol.36 (2): 87-89

Risk of serious adverse events after primary shoulder replacement: development and external validation of a prediction model using linked national data from England and Denmark

Despite a rising rate of serious medical complications after shoulder replacement surgery, there are no prediction models in widespread use to guide surgeons in identifying patients at high risk and to provide patients with personalised risk estimates to support shared decision making. Our aim was to develop and externally validate a prediction model for serious adverse events within 90 days of primary shoulder replacement surgery. Linked data from the National Joint Registry, National Health Service Hospital Episode Statistics Admitted Patient Care of England, and Civil Registration Mortality databases and Danish Shoulder Arthroplasty Registry and National Patient Register were used for our modelling study. Patients aged 18-100 years who had a primary shoulder replacement between April 1, 2012, and Oct 2, 2020, in England, and April 1, 2012, and Oct 2, 2018, in Denmark, were included. We developed a multivariable logistic regression model using the English dataset to predict the risk of 90-day serious adverse events, which were defined as medical complications requiring admission to hospital and all-cause death. We undertook internal validation using bootstrapping, and internal-external cross-validation across different geographical regions of England. The English model was externally validated on the Danish dataset. Data for 40 631 patients undergoing primary shoulder replacement (mean age 72·5 years [SD 9·9]; 28 709 [70·7%] women and 11 922 [29·3%] men) were used for model development, of whom 2270 (5·6%) had a 90-day serious adverse event. On internal validation, the model had a C-statistic of 0·717 (95% CI 0·707-0·728) and was well calibrated. Internal-external cross-validation showed consistent model performance across all regions in England. Upon external validation on the Danish dataset (n=6653; mean age 70·5 years [SD 10·3]; 4503 [67·7%] women and 2150 [32·3%] men), the model had a C-statistic of 0·750 (95% CI 0·723-0·776). Decision curve analysis showed clinical utility, with net benefit across all risk thresholds. This externally validated prediction model uses commonly available clinical variables to accurately predict the risk of serious medical complications after primary shoulder replacement surgery. The model is generalisable and applicable to most patients in need of a shoulder replacement. Its use offers support to clinicians and could inform and empower patients in the shared decision-making process. National Institute for Health and Care Research and the Department of Orthopaedic Surgery, Herlev and Gentofte Hospital, Denmark.

Comparison the Results of Humerus Shaft Fractures Treated by Functional Bracing versus Dynamic Compression Plate

Introduction with Objective: To compare the results of humerus shaft fractures treated by functional bracing and dynamic compression plate. Materials and Methods: This experimental study was carried out at the Department of Orthopedic Surgery at Chittagong Medical College Hospital, Chattogram from August 2019 to July 2021. All adult patients of closed diaphyseal fracture of humerus attending the Orthopaedics department, Chittagong Medical College Hospital during study period were the study population. Purposive sampling was done according to availability of the patients. Cases were divided in two groups; group A (dynamic compression plate) and group B (functional bracing). All the data were compiled and sorted properly and the quantitative data was analyzed statistically by using Statistical Package for Social Science. The results were expressed as percentage and mean ± SD and p&lt;0.05 was considered as the level of significant. Result: Average mean ± SD age was 40.22 ± 12.451 (range: 19-65) years. The mean age was 37.24 ± 10.686 in plating group and 43.20 ± 13.559 in bracing group. Out of 50 patients, 30 (60%) were male and 20 (40%) were female. Male was predominant in both groups (P=0.564). Regarding time taken for radiological union, average mean ± SD time was 15.32 ± 2.613 (range: 12-22) weeks. The mean time for radiological union was 14.91 ± 2.712 weeks in plating group and 15.76 ± 2.488 weeks in bracing group. Regarding ROM of shoulder &amp; elbow, there was statistically nonsignificant difference found between the groups except shoulder flexion (P= 0.031s), abduction(P=0.025s) &amp; extension(P=0.041s) more on plating group. QUICK-DASH score at 3 month shows highly significant difference between the study groups (p=0.001). At 6 and 12 month significant difference was found between the groups. Out of 44 patients at 12 months follow-up, 19 (43.2%) patient’s functional outcome was excellent and 10 (22.7%) patient’s functional outcome was good. Statistically significant difference was found between the groups (p=0.022). Conclusion: This study observed that functional outcome was relatively better in patients treated by dynamic compression plate in adult diaphyseal fracture of humerus. Medicine Today 2024, Vol.36 (2): 82-86

Outcome of Posterior Lumbar Interbody Fusion (PLIF) with Cage and Bone Graft in The Treatment of Degenerative Lumbar Spinal Canal Stenosis

Introduction: Posterior lumbar interbody fusion (PLIF) is a reliable treatment option for patients with Lumbar canal stenosis &amp; spondylolisthesis; providing spinal stabilization in a balanced alignment with the disc space height restored and with the neural elements being decompressed mechanically. The titanium cages provided immediate stability to spinal levels, restoration of the disc space and neuro-foraminal area, and an increased surface area leading to successful fusion. Materials and Methods: This prospective study was carried out at the Department of Orthopedic Surgery at DMCH, Dhaka within the defined period. All the data were compiled and sorted properly and the quantitative data was analyzed statistically by using Statistical Package for Social Science. The results were expressed as percentage and mean ± SD and p&lt;0.05 was considered as the level of significant. Result: Mean age of the study population was 51.32±8.29 with a female: male ratio 1.6 :1 where maximum patient was housewife (57.14%). 60.72% patients had only single level involvement while 39.28% patients had multi-level involvement. Mean VAS score reduced significantly at final follow-up (6.55±0.66 to 2.29±0.46 for back pain and 6.59±0.65 to 1.21±0.42 for leg pain. Mean ODI score decreased significantly from 56.71±3.09 to 15.82±3.46 at final follow-up. Radiologically Grade-I fusion achieved in 89.28% cases. Overall functional outcome was excellent (89.29%) &amp; good (7.14%) according to Modified Macnab criteria. Conclusion: Posterior lumbar interbody fusion (PLIF) with cage and bone graft in the treatment of degenerative lumbar spinal canal stenosis provides excellent neurological and functional outcome and fusion rate at final follow-up. Medicine Today 2024, Vol.36 (2): 72-75

Comparison of the functional outcome of Philos Plate Vs. external fixator in the management of proximal humerus fracture

Background: Proximal humerus fractures, are a major medical issue that are relatively prevalent. 4-5% of all fractures are proximal humeral fractures, most of which involve older and osteoporotic individuals. Objectives: To compare the functional outcome of philos plate vs. external fixator in the management of proximal humerus fracture. Material and Methods: A retrospective comparative study was conducted at the Department of Orthopaedic Surgery, Ghurki Trust Teaching Hospital, Lahore. From November 23, 2022, to May 23, 2023. After approval from the hospital's ethical board, 112(56 per group) patients were included in the study through an emergency. Informed consent was taken from parents. We stratified patients into two groups. Group A received the treatment of Philos, while Group B received the external fixator treatment. Functional outcome was assessed at the end of 3 months postoperatively using constant shoulder score. The collected data were entered and analyzed accordingly using SPSS version 27. Results: In the current study, a total of 112 patients included underwent two surgical interventions, among these, 56 patients underwent Philos plating while an equal number of patients underwent external fixation. In Group A and B, the majority were males (37:47) out of 112. The mean age of patients was equal in both groups (Group A=44.36±11.71), and the mean age of patients was (Group A=44.88±10.05), ranging from 20 to 80 years. In Group A, the average BMI was less than 24.29±4.23, ranging from 18-35 kg/m2, compared to Group B, 28.89±3.77, ranging from 22-35 kg/m2. 38(67.9%) were effected from right side as in Group A while 41(73.2%) were effected from right side in Group B. Majoruty 28(50.0%) had history of RTA in Group A while patients 24(42.9%) were observed with history of RTA in Group B25(44.6%) cases reported excellent outcome, 6(10.7%) reported very good outcome, 16(21.4%) good, 7(12.5%) fair and 2(3.6%) poor outcome in Group A. In Group B, 36(64.3%) excellent, 7(12.5%) very good, 12(21.4%) cases reported Good and 1(1%) reported fair outcome. So it is concluded that 25(44.6%) cases reported excellent outcome in Group A, comparatively low as compared to Group B 36(64.3%). Only age was significantly associated with excellent outcomes as p&lt;.05. Conclusion: It is concluded that External fixation demonstrated a better outcome as compared to Philos Plating, so in Orthopaedic practice, External fixation should be preferred for patients diagnosed with proximal humerus fracture to get better results and reduce the complications.

Functional outcome of internal fixation of tibial plateau fractures: an observational study

Background: Tibial plateau fractures are intra-articular fractures usually caused by high energy trauma either a valgus or varus force in combination with axial loading which affect the stability and function of weight bearing knee joint. Understanding the outcomes of surgical treatment for these fractures is crucial for both orthopaedic research and patient care. This study set out to examine the functional results of surgically managing tibial plateau fractures. Methods: This prospective observational study took place in the Department of Orthopedic Surgery at Bangabandhu Sheikh Mujib Medical University in Dhaka, Bangladesh, from January 2020 to December 2022. The study included 37 patients with tibial plateau fractures who underwent internal fixation. Data was analyzed using tools from Microsoft Office. Results: Among the study participants, 56.8% had an immobilization period of 1 week or less, and 32.4% were immobilized for 2-3 weeks. Complications included knee stiffness in 10.8% and malunion in 8.1% of cases. According to the Rasmussen grading system, 51.4% achieved an excellent outcome, 35.1% were categorized as good, while 8.1% and 5.4% fell into the fair and poor categories. Functional outcome was assessed by Oxford knee score is excellent 20 (54.5%), good 11 (29.7%), fair 4 (10.8%) and poor 2 (5.4%) respectively. Conclusions: Surgical treatment of tibial plateau fractures typically yields positive results in most cases. The use of internal fixation, particularly with locking compression methods, is considered an effective approach for treating these fractures. This technique is associated with a lower risk of complications and promotes efficient healing, contributing to favourable outcomes.