Outcomes In Terms Of Range Research Articles

Clinical outcome of dorsal versus lateral plating in proximal phalangeal fracture: A retrospective study

Background: Plating of proximal phalangeal fracture is the commonly adopted fixation method. However, whether placing the implant at the dorsal or lateral aspect of the phalanx can yield a better clinical outcome is still under debate. Our study aims to compare the functional outcome of dorsal plating versus lateral plating in patients suffering from a proximal phalangeal fracture. Methods: A retrospective comparative study was performed comparing the clinical outcome of dorsal and lateral plating in proximal phalangeal fracture. Fourteen patients from our center with a total of 17 proximal phalangeal fractures (excluding the thumb) were included in this study. The total range of movement and range of movement of each finger joint together with grip strength were the main focuses of this study. Operative complications and the need for subsequent related operations were also analyzed. Results: Nine cases were treated by dorsal plating and eight cases adopted lateral plating. There was no significant difference in demographic data between the two groups with a mean follow-up period of 20.75 months. Lateral plating provided better total range of movement (dorsal plating (D): 203.9 ± 35.2 vs. lateral plating (L): 248.8 ± 23.7; p-value = 0.01) and percentage change in total range of movement (D: 79.41% ± 10.35, L: 94.47% ± 6.09; p-value < 0.01). There was less extension lag in lateral plating as evidenced by the sum of extension lag of the three finger joints being statistically significantly smaller (D: 32.8 ± 14.2 vs. L: 4.44 ± 6.2, p < 0.01). Less percentage decrease in grip strength compared with the contralateral normal hand was also noted in the lateral plating group (D: 68.17% ± 31.11 vs. L: 98.13% ± 10.88, p = 0.02). Conclusions: Based on this study, lateral plating provides better functional outcomes in terms of range of movement, extension lag, and grip strength than dorsal plating. Level of Evidence: Therapeutic, retrospective comparative study, Level III.

Evaluation of functional results of different treatment modalities in Intra- articular fracture of distal end of radius in adults at a tertiary care hospital in Eastern India

Fractures of the distal radius (DRF) are the most common orthopedic injuries: one out of every six fractures presented at emergency department is a distal radius fracture. Almost two-thirds of these fractures are displaced and need to be reduced. Epidemiological studies point out that the age rate curve is bimodal and that the highest incidences are found in children and the elderly. DRF constitute 14% of all extremity injuries. They occur as a result of high or low energy trauma resulting in significant injury and impairment of function of the upper extremity. Randomized controlled trial has been attempted to scrutinize the best method for treating DRF, ranging from methods of conservative treatment to advanced strategies of plate osteo-synthesis.124 Patients with 126 intra-articular distal radius fractures were studied, who met with predefined inclusion and exclusion criteria at Department of Orthopaedics, Kalinga Institute of Medical Sciences, Bhubaneswar from 1st October 2017 to 30th September 2019. They underwent different treatment interventions. The cases were followed for 12 months at regular intervals for serial clinical & radiological evaluation. Functional grading and pain scoring was done for different treatment modalities. Radiological grading was made based on union/ non-union of fracture.Majority with wrist fracture were of age 20-40 years followed by the age group 61-80 years. Grip strength was reported better in surgical group(79.2%). Mode of treatment is statistically significant with Palmar flexion (p = 0.015), Supination (p=0.025) and Pronation (p<0.001) of wrist post surgical treatment. Plating group experience significantl less pain (p=0.012). Mean function score for surgical group is 19.8.The impetus for the inclination towards treatment of wrist fracture by surgery, mainly plating method, stands multifactorial and might bring better outcomes in terms of range and degree of movement, expedited recovery, lower chances of malunion and in a way, better prognosis and quality of life in case of DRF.

ANTERIOR ELBOW DISLOCATION WITHOUT NEUROVASCULAR INJURY- A RARE CASE REPORT

Introduction- Of all the injuries around elbow joint, simple anterior elbow dislocation is of rare occurrence usually as a result of direct injury to proximal ulna after fall on semi-exed elbow. A 6year-old female child presente Case report- d to emergency department of our hospital with history of fall from 11 feet height followed by pain, deformity, swelling around left elbow and forearm. Digital radiographs suggestive of anterior elbow dislocation, which was managed successfully with closed reduction. Si Conclusion- mple anterior elbow dislocation in paediatric population is a rare entity and closed reduction is treatment of choice followed by physiotherapy under-supervision for good functional outcome in terms of range of motion.

Closed reduction and internal fixation with titanium elastic nailing system in pediatric both-bone forearm fractures

<p class="abstract"><strong>Background:</strong> The present study is designed to analyse the postoperative clinical and functional outcome of closed reduction and internal fixation of pediatric both-bone forearm fractures with titanium elastic nailing system (TENS).</p><p class="abstract"><strong>Methods:</strong> A total of 32 patients in the age group of 5 to 15 years with fracture both-bone forearm underwent closed reduction and internal fixation with TENS at our hospital. Patients with displaced fractures having angulation more than 10° and rotation of more than 45° or fractures with unacceptable reduction post conservative management were included in this study. For functional outcome, upper extremity rating scale (UERS) was used to evaluate the range of motion and grip strength.<strong></strong></p><p class="abstract"><strong>Results:</strong> Patients were followed up for a period of 6 months. In all cases fracture united in the range of 6-14 weeks without any malunion. All 32 cases had excellent outcomes according to UERS score. Two patients had deficient forearm pronation of 10° and 15° respectively. Skin irritation and implant impingement was seen in two patients each at final follow-up.</p><p class="abstract"><strong>Conclusions:</strong> Closed reduction and internal fixation with TENS seems to be a good treatment option for fixation of pediatric both bone forearm fractures. It gives excellent functional outcome in terms of range of motion and grip strength without any major complications.</p>

COMPARATIVE EVALUATION OF FUNCTIONAL OUTCOME OF OPEN REDUCTION AND INTERNAL FIXATION WITH PHILOS AND CLOSED REDUCTION AND PERCUTANEOUS FIXATION WITH K-WIRES IN PROXIMAL HUMERAL FRACTURES

Background: Fracture of the proximal humerus represents the second most common (29.1%) fracture type in the upper extremity after Colle's fracture (37.2%) of the wrist. Signicant controversy continues regarding the best modality for treating displaced proximal humerus fractures. The objective of our study is to comparatively evaluate the functional outcome of ORIF with Proximal Humerus Internal Locking System (PHILOS) and Close Reduction and Percutaneous Fixation with K-wires in proximal humerus fractures. Method: A prospective study was conducted after getting ethical approval at N.S.C.B. Medical College & Hospital, Jabalpur, (M.P.) upon 50 cases admitted with proximal humerus fractures as per inclusion criteria. 25 cases were treated with PHILOS plate in group A and 25 patients were treated with Closed Reduction and Percutaneous Fixation with K-wires in group B. Post op follow up was done at 6 weeks and 12 weeks and functional outcome evaluated by Neer's scoring criteria. Results: Out of 50 cases, excellent scores was obtained in 22 (88%) cases treated with PHILOS in group A, and 18 (72%) cases treated with k-wire xation in group B, satisfactory score was obtained in 3 (12%) in Group A and 6 (24%) in Group B. Conclusion: We obtained excellent results in both groups with each procedure having its own advantage and disadvantages. We found that PHILOS provides secure xation with better functional outcome in terms of range of motion. Fixation with Percutaneous K-wires is also efcient treatment option with intraoperative advantage in terms of invasiveness, blood loss and time taken for surgery with least tissue dissection than PHILOS plating

Stabilization for acute distal radioulnar instability: A novel surgical technique

IntroductionInstability of the distal radioulnar joint (DRUJ) commonly results from traumatic disruption of the distal radioulnar ligaments of the triangular fibrocartilage complex (TFCC). Treatment of this rupture typically requires immobilization of the wrist and elbow for a period of 6 to 8 weeks. This study evaluated the hypothesis that treatment of DRUJ instability with dynamic stabilization would allow early mobilization of both the radiocarpal and distal radioulnar joints by the first postoperative week without compromising restoration of TFCC integrity. Materials and methodsBetween September 2017 and January 2019, a retrospective study was conducted on 22 patients presenting with DRUJ instability confirmed by intraoperative Ballottement testing. Once instability was confirmed, dynamic surgical stabilization was performed, followed by one week of short cast immobilization. Arthrographic computed tomography (CT) of each patients’ affected wrist was performed 4 months later to evaluate TFCC integrity. The recovery of patients was monitored at 1, 3, 6, and 12 months after surgery using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, Ballottement test, and evaluation of radioulnar join range of motion (ROM), pain, and complications. ResultsAll patients were followed postoperatively for a mean of 13.5 months. After 1 month, all patients exhibited satisfactory range of motion and DRUJ stability. By 3 months, Ballottement tests were negative in 21 of 22 patients, with instability persisting in only 1 patient. At 4 months, CT arthrography contrast leakage (indicative of a TFCC tear) was observed in 5 of 20 patients. Upon reexamination a mean of 10.5 months later, the TFCC tears of these patients had healed in 2 cases (with foveal tears), while no difference in contrast leakage was observed for the other 3 cases (with horizontal or central tears). Revision surgery for implant related complications was performed in 2 cases. ConclusionAcute DRUJ instability treated with dynamic stabilization led to satisfactory clinical outcomes in terms of range of motion, pain relief and joint stability, allowing DRUJ movement from the first postoperative week. This technique represents a simple, reproducible and minimally invasive procedure with a low rate of implant related complications.

Comprehensive–Comparative study of fracture distal end radius with plating and K-Wire fixation

Introduction: Distal end radius fracture is a common fracture seen in the routine orthopedic outpatient department. The optimal management of distal radius fractures remains controversial. Aim: The aim of the study is to compare the functional outcomes folloing volar plating and K-ire fixation of the distal end radius fractures and to compare hich method produced better result. The functional outcome in terms of range of movements, pain, and grip strength of the patients as assessed at 6 months in both groups by demerit score system of Gartland and Werley. Material and Methods: The ORIF group as treated ith volar plating and CRIF group ith k ires. The functional outcome as measured using Gartland and Werley system. Results: Functional outcome as per Gartland and Werley as 95% excellent-to-good results in the plating group as compared to 75% in the K-ire fixation group. Conclusion: The study emphasizes that open reduction and internal fixation ith volar plating has excellent functional outcome hen compared to K-ire fixation in distal radius fractures. When considering the cost, K-ire fixation is preferred over volar plating.

Mobile bearing vs fixed bearing total knee arthroplasty-shortterm outcome and postoperative recovery analysis

Background: Controversy exists regarding the clinical and functional outcome of mobile bearing compared to fixed bearing total knee prostheses. Even though lot of studies have compared the long term results, few have studied the early postoperative recovery, short term functional outcome and clinical outcome in terms of range of motion Objective: The purpose of this prospective clinical study was to compare the postoperative recovery, short term functional outcome and short term clinical outcome in terms of range of motion of 2 groups of patients undergoing total knee arthroplasty. Method: 25 patients who received a fixed bearing prosthesis (posterior stabilised PS) was compared with 25 patients who received a mobile bearing prosthesis (rotating platform RP). They were followed up at regular intervals using Knee society clinical and functional scoring system Results: At an average follow-up of 12 months, there was significant postoperative improvement in both groups; but there was no significant difference between the groups with regard to the mean postoperative range of motion (92.56 in PS and 99.16 in RP respectively; p=0.239), the mean KSS clinical score (84.76 in PS and 83.4 in RP respectively; p=0.542), or the mean KSS functional score (70.6 in PS and 75.2 in RP respectively; p=0.263). Using a fixed-bearing or a mobile-bearing design did not seem to grossly influence the short-term recovery and early results after knee arthroplasty.

Deformity correction and extremity lengthening in the lower leg: comparison of clinical outcomes with two external surgical procedures.

Objective Distraction osteogenesis is a method of stimulating the growth of new bone tissue in order to lengthen the extremities or bridge resected bone defects. In addition to the now-established intramedullary procedures, two different fixator systems are in use. The present study investigated the classical Ilizarov ring fixator (IRF) and a hexapod to assess the precision of lower-leg lengthening and complications classified using the Paley criteria for problems, obstacles, and complications. The study also examined the follow-up results in functional tests to assess outcomes in terms of range of motion in adjacent joints, daily activities, and quality of life. Patients and methodsA total of 43 patients (53 segments) who were treated over a period of 16 years were re-assessed. In 33 segments, treatment was carried out with the hexapod Taylor Spatial Frame (TSF); the conventional IRF was used in 20 segments. The patients’ mean age was 13.5 years (range 2–54 years). The follow-up examinations were carried out 2–15 years postoperatively and comprised measurement of a current leg axis view with the patient standing, calculation of a knee score, activity scores, ankle joint scores, and assessment of motor function and sensory function using appropriate scores in the lower leg and foot. The post-treatment health-related quality of life was assessed using the Short-Form Health Survey-36 questionnaire. ResultsUsing the Paley criteria, far fewer problems occurred in the TSF group in comparison with the IRF (TSF 12.1%, IRF 50%). In the problems category, significant differences were observed with regard to axial deviation (TSF 0%, IRF 36.8%) and pin infections (TSF 9.1%, IRF 40%). Comparison of the obstacles and complications did not identify any significant differences between the two groups. Analysis of the scores for the knee, activity, and motor function/sensory function also did not show any marked discrepancies, apart from a major difference in mobility in the upper and lower ankle joints with poorer findings in the TSF group.ConclusionsDuring treatment, the TSF ring fixator leads to fewer problems, fewer secondary axial translations, and fewer pin infections. However, with temporary transfixation of the ankle joints, the TSF system is also associated with postoperative deterioration in mobility in the upper and lower ankle joint.

Does Injection of Corticosteroid After Arthrocentesis Improve Outcomes of Temporomandibular Joint Osteoarthritis? A Randomized Clinical Trial

The purpose of this study is to answer the following clinical question: Among patients with temporomandibular joint (TMJ) osteoarthritis (OA), do those undergoing arthrocentesis and corticosteroid (CS) injection, when compared with those undergoing arthrocentesis alone, have better outcomes in terms of range of motion and clinical symptoms? A randomized clinical trial in adult patients with TMJ OA referred to our clinic between May 2012 and September 2013 was implemented. The sample was composed of 24 consecutive patients with TMJ OA treated randomly with either arthrocentesis alone (control group) or arthrocentesis plus CS injection (CS group). The outcome variables were visual analog scale evaluations (ie, masticatory efficiency, joint sounds, and pain complaints), maximal interincisal opening, and mandibular motions. The outcome variables were recorded at baseline and at 12months postoperatively. The Mann-Whitney U test was used for intergroup comparison. The paired t test and Wilcoxon signed rank test were used for intragroup comparisons. The sample was composed of 32 joints in 24 patients with TMJ OA (15 joints in 12 patients with a mean age of 35.08 ± 14.84years comprising the control group and 17 joints in 12 adult patients with a mean age of 32.58 ± 9.58years comprising the CS group). Pain complaints and joint sounds showed statistically significant decreases (P < .01) in both groups, whereas painless interincisal opening showed a statistically significant increase (P < .001) in only the CS group. After estimation of differences between the follow-up and baseline outcomes, the mean change in the primary outcome variables showed no statistically significant differences between the 2 groups (P > .05). These findings suggest that arthrocentesis plus intra-articular CS injection produced no better outcomes in terms of range of motion and clinical symptoms in patients with TMJ OA, as compared with those undergoing arthrocentesis alone.

Combined Anterior and Posterior Approach in Total Hip Arthroplasty for Crowe IV Dysplasia or Ankylosed Hips

We evaluated 70 patients (71 hips) who underwent complex total hip arthroplasty (THA) through the combined anterior and posterior approach. Sixty-five patients (32 dislocated hips and 34 ankylosed hips) were followed-up at a minimum of 3 years (median, 6 years; range, 3–10 years). Seven patients (10.6%), who had transient paresthesia on the anterior thigh, recovered within 3 months. All patients had a good clinical outcome in terms of range of motion, pain and recovery of walking. At the latest follow-up, all prostheses had bone-ingrown stability without any detectable wear or osteolysis. The combined approach allows an excellent exposure of the acetabulum for accurate cup alignment, leg lengthening and mobilization of joint in complex THA without trochanteric osteotomy, excessive abductor release and femoral shortening osteotomy.

Midterm Results of Surgical Hip Dislocation for the Treatment of Femoroacetabular Impingement

Background: Surgical treatment of femoroacetabular impingement (FAI) includes both open and arthroscopic procedures. Encouraging results have been reported for the majority of patients after surgical hip dislocation; however, most of these reports were short term and included only small cohorts. Purpose: To determine the results of surgical hip dislocation in a large cohort of FAI patients at a midterm follow-up. Study Design: Case series; Level of evidence, 4. Methods: A retrospective study including 185 consecutive patients (mean age, 30 years; 40% female) with 233 hips treated was conducted. We determined clinical outcomes in terms of range of motion and analyzed radiographs for several criteria including the alpha angle preoperatively and at 1 year postoperatively. At latest follow-up, on average 61 months postoperatively, patient satisfaction, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Hip Outcome Score, SF-12, and University of California, Los Angeles (UCLA) activity scale scores were determined. All revisions and conversions to total hip arthroplasty (THA) were recorded. Results: Both hip flexion and internal rotation improved from preoperatively to postoperatively. Alpha angles decreased from 65.1° ± 14.2° to 42.4° ± 4.9°. At 5 years, 82% of the patients were satisfied or very satisfied with the results of surgery, and 81% would undergo the same surgery again. There were 83% who rated their overall hip function as normal or nearly normal. Mean scores for the WOMAC pain, stiffness, and function subscales were 10.3 ± 15.8, 15.9 ± 17.4, and 9.6 ± 13.0 points; for Hip Outcome Score activities of daily living and sport subscales were 89.0 ± 13.1 and 75.6 ± 23.0 points; and for the SF-12 Physical Component Scale and Mental Component Scale were 47.4 ± 6.3 and 52.3 ± 7.4 points, respectively. The mean UCLA activity level was 7.7 ± 1.9. Conversion to THA was performed in 7 hips (3%). Seven hips (3%) underwent other major revisions, and 11 (4.7%) underwent minor revisions. Female patients had a significantly increased risk for conversion to THA (odds ratio, 13.3; 95% confidence interval [CI], 1.3-92.6) and major revision (odds ratio, 19.2; 95% CI, 2.4-152.9). The mean body mass index was significantly lower in those patients who underwent conversion to THA. The need for microfracture because of residual full-thickness cartilage defects after rim trimming was a significant (P = .04) predictor of subjective dissatisfaction. Conclusion: This study demonstrates that surgical hip dislocation is a successful procedure for the treatment of FAI. A majority of patients were satisfied with the results of surgery at a midterm follow-up. Older and slim female patients were at an increased risk for a less successful outcome in terms of conversion to THA and revision surgery.