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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Online ISSN Number 2455-538X
Acute Knee Dislocation with Neurovascular Injury- Salvage or Amputation? A Case Report
/in January-June 2022 | Volume 8 | Issue 1Vol 8 | Issue 1 | January-June 2022 | page: 15-18 | Ajay Kurahatti, Hariprasad S, Satyarup D
DOI: 10.13107/ti.2022.v08i01.024
Authors: Ajay Kurahatti [1], Hariprasad S [1], Satyarup D [1]
[1] Department of Orthopaedics, Sri Devaraj Urs Medical College, Kolar, Karnataka, India.
Address of Correspondence
Dr. Ajay Kurahatti,
Assistant Professor, Department of Orthopaedics, Sri Devaraj Urs Medical College, Kolar, Karnataka, India.
E-mail: ajaykurahatti@gmail.com
Abstract
Introduction: Traumatic knee dislocation is considered an orthopedic emergency. Knee dislocations are relatively infrequent injuries. This injury frequently occurs from high-energy impact trauma. Neurovascular injuries can result in debilitating consequences if the diagnosis and treatment are delayed. Associated complications include degenerative arthritis, permanent neurovascular injury, and amputation. The poorest prognosis is seen in patients with knee dislocation longer than 6-8 hours before reduction.
History: The 25-year-old male patient presented with a history of a road traffic accident to the emergency department. The patient presented with swelling, pain, and deformity of the left knee and leg. Examination: On examination, the patient had tense swelling and tenderness of the left knee joint and leg. Visible deformity of the left knee joint is seen. The posterior tibial artery and dorsalispedis artery were not palpable. Active ankle and toe movements were absent.
Investigations: Plain radiograph was taken at the emergency department of the left knee and leg. X-rays showed anterior dislocation of the knee joint.
Treatment: After valid written informed consent, the dislocated left knee joint was reduced under sedation in the operation theatre and immobilized in the above knee plaster slab. Reduction of the knee joint was done within 4 hours of injury. Then the distal pulses were re-assessed. The posterior tibial and dorsalispedis artery was absent. Hence, MR Angiography of the left lower limb was done. It showed popliteal artery transection. So, the artery was explored and end-to-end vascular anastomosis was done. A knee-spanning external fixator was applied to the left lower limb. Fasciotomy was done for the tense leg compartments. After a week, the fasciotomy wounds were infected for which extensive debridement of the wounds was done and antibiotic beads were placed. Knee was mobilized with a gradual range of motion exercises and non-weight bearing mobilization with a foot drop splint. Gradually full weight-bearing ambulation was allowed.
Conclusion: Knee dislocation is rare, albeit a serious and potentially limb-threatening condition. The prognosis of knee dislocations is variable and is heavily dependent on the time interval between trauma and initiation of management. Immediate, timely, and proper management can salvage the limb, and amputation is not the only solution.
Keywords: Dislocation, Posterior tibial artery, Fasciotomy
References
1. Jacodzinski M, Petri M. (2014). Knee dislocations and soft tissue injuries. Skeletal Trauma: Basic Science, Management and reconstruction, Philadelphia, Saunders, 1907-36.
2. Whelan AB, Levy BA. Knee dislocations. Rockwood and Green’s Fractures in Adults, Lippincott Williams & Wilkins, 2369-414.
3. Miller HH, Welch CS. (1949) Quantitative studies on the time factor in arterial injuries. Ann Surg, 130, 428-30.
4. Green NE, Allen BL. Vascular injuries associated with dislocation of the knee. J Bone Joint Surg Am 1977; 59(2): 236-9.
5. Merrill KD. Knee dislocations with vascular injuries. Orthop Clin North Am 1994; 25(4): 707-13.
6. Howells NR, Brunton LR, Robinson J, Porteus AJ, Eldridge JD, Murray JR. Acute knee dislocation: an evidence-based approach to the management of the multiligament injured knee. Injury 2011; 42(11): 1198-204.
7. Mills WJ, Barei DP, McNair P. The value of the ankle-brachial index for diagnosing arterial injury after knee dislocation: a prospective study. J Trauma 2004; 56(6): 1261-5.
8. Sisto DJ, Warren RF. Complete knee dislocation. A follow-up study of operative treatment. Clin Orthop Relat Res 1985(198): 94- 101.
9. Harner CD, Waltrip RL, Bennett CH, Francis KA, Cole B, Irrgang JJ. Surgical management of knee dislocations. J Bone Joint Surg Am 2004; 86-A(2): 262-73.
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Ischiofemoral Impingement Surgery Following Lumbar Spine and Sacroiliac Joint Fusion: A Case Report
/in January-June 2022 | Volume 8 | Issue 1Vol 8 | Issue 1 | January-June 2022 | page: 11-14 | Steven Gonzales Farrell, Munif Hatem, Hal David Martin
DOI: 10.13107/ti.2022.v08i01.023
Authors: Steven Gonzales Farrell [1], Munif Hatem [2], Hal David Martin [2]
[1] Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States.
[2] Department of Orthopaedic Surgery, Baylor University Medical Center, Dallas, TX.
Address of Correspondence
Dr Steven Gonzales,
Rutgers Robert Wood Johnson University Hospital, New Brunswick, New Jersey, United States.
E-mail: stevefarrell125@gmail.com
Abstract
Introduction: Ischiofemoral impingement is a cause of posterior hip pain and limitation in hip extension. The compensatory motion at the lumbar spine associated with limitation in hip mobility has been associated with low-back pain, and an increase of 30% in the load at L3-L4 and L4-L5 lumbar facet joint is reported in a cadaveric study involving simulated ischiofemoral impingement.
Case Presentation: A 66-year-old female developed low back pain associated with bilateral hip pain over a period of 12 years. The symptoms persisted despite 5 surgical interventions in the lumbar spine and sacroiliac joints. Impingement between the lesser trochanter and ischium, with limitation of hip extension, was identified on the physical examination and imaging studies. The patient underwent endoscopic partial resection of the lesser trochanter bilaterally. The Oswestry lumbar disability index improved from 56% before surgery to 14% at the 17-month follow-up. Impingement between the lesser trochanter and ischium should be considered in the differential diagnosis of low back pain.
Conclusion: Ischiofemoral impingement should be considered as a differential diagnosis for patients with unsuccessful lumbar spine surgery.
Keywords: Ischiofemoral impingement, Low back pain, Hip pain
References
1. Johnson KA. Impingement of the lesser trochanter on the ischial ramus after total hip arthroplasty. Report of three cases. J Bone Joint Surg Am. 1977;59(2):268-269.
2. Truong WH, Murnaghan L, Hopyan S, Kelley SP. Ischioplasty for Femoroischial Impingement. J Bone Joint Surg Am. 2012;2(3):2-6.
3. Torriani M, Souto SCL, Thomas BJ, Ouellette H, Bredella M a. Ischiofemoral impingement syndrome: an entity with hip pain and abnormalities of the quadratus femoris muscle. AJR Am J Roentgenol. 2009;193(1):186-190.
4. Hatem MA, Palmer IJ, Martin HD. Diagnosis and 2-year outcomes of endoscopic treatment for ischiofemoral impingement. Arthroscopy. 2015;31(2):239-246.
5. Patti JW, Ouellette H, Bredella MA, Torriani M. Impingement of lesser trochanter on ischium as a potential cause for hip pain. Skeletal Radiol. 2008;37(10):939-941. doi:10.1007/s00256-008-0551-3
6. Tosun O, Algin O, Yalcin N, Cay N, Ocakoglu G, Karaoglanoglu M. Ischiofemoral impingement: evaluation with new MRI parameters and assessment of their reliability. Skeletal radiology. 2012;41(5):575-587. doi:10.1007/s00256-011-1257-5.
7. Hatem M, Martin HD. Low Back Pain Improves After Surgery for Lesser Trochanteric–Ischial Impingement. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021; 37 (5): 1503-1509. doi: 10.1016/j.arthro.2021.01.006.
8. Tosun O, Cay N, Bozkurt M, Arslan H. Ischio femoral impingement in an 11-year-old girl. Diagn Interv Radiol. Published online 2012. doi:10.4261/1305-3825.DIR.5728-12.1
9. Gómez-Hoyos J, Khoury A, Schröder R, Johnson E, Palmer IJ, Martin HD. The Hip-Spine Effect: A Biomechanical Study of Ischiofemoral Impingement Effect on Lumbar Facet Joints. Arthroscopy. 2017;33(1):101-107.
10. Fairbank JCT, Pynsent PB. The Oswestry Disability Index. Spine. 2000;25(22):2940-2953.
11. Atkins PR, Fiorentino NM, Aoki SK, Peters CL, Maak TG, Anderson AE. In Vivo Measurements of the Ischiofemoral Space in Recreationally Active Participants During Dynamic Activities: A High-Speed Dual Fluoroscopy Study. The American journal of sports medicine. 2017;45(12):2901-2910.
12. DiSciullo AA, Stelzer JW, Martin SD. Dynamic Ischiofemoral Impingement: Case-Based Evidence of Progressive Pathophysiology from Hip Abductor Insufficiency: A Report of Two Cases. JBJS case connector. 2018;8(4):e107.
13. Siebenrock KA, Steppacher SD, Haefeli PC, Schwab JM, Tannast M. Valgus hip with high antetorsion causes pain through posterior extraarticular FAI. Clinical orthopaedics and related research. 2013;471(12):3774-3780.
14. Morris WZ, Fowers CA, Weinberg DS, Millis MB, Tu LA, Liu RW. Hip morphology predicts posterior hip impingement in a cadaveric model. HIP International. 2019;29(3):322-327.
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Is the Nomenclature of Massive Rotator Cuff Tear Used Correctly? Systematic Review
/in January-June 2022 | Volume 8 | Issue 1Vol 8 | Issue 1 | January-June 2022 | page: 06-10 | Alper Deveci, Hakan Dur, Erkan Alkan
DOI: 10.13107/ti.2022.v08i01.022
Authors: Alper Deveci [1], Hakan Dur [1], Erkan Alkan [1]
[1] Department of Orthopaedics and Traumatology, Faculty of Medicine, Yuksek Ihtisas University, Ankara, Turkey.
Address of Correspondence
Dr. Alper Deveci,
Department of Orthopaedics and Traumatology, Faculty of Medicine, Yuksek Ihtisas University, Ankara, Turkey.
E-mail: alperdeveci57@gmail.com
Abstract
Background: The term massive refers to a quantitative measure of the rotator cuff tears. Irreparable rotator cuff tear is indicated by ratings that qualitatively evaluate the repairability of the tendon. These two terms should be considered separately.
Methods: Between 2016 and 2022, publications in the last about 5 years were searched from Pubmed and MEDLINE online databases. The search terms (irreparable OR massive) AND (rotator cuff tear), (repairable OR massive) AND (rotator cuff tear), (massive OR retracted) AND (rotator cuff tear), (irreparable OR retracted) AND (rotator cuff tear) ”were used. For each search term, it was checked whether the title of the search term was mentioned in the title of the article, and whether the title and the content were compatible in the studies in which the searched term was mentioned in the title.
Results: Of the 934 scanned articles, 69 of them were evaluated in terms of study title and material-method compatibility. 22 articles with the term “massive rotator cuff tear” in the title were identified. It was seen that in 11 of these 22 articles (50%), the title and the material method were compatible and in 11 of them (50%) the title and the content were incompatible, and the term “massive” was used instead of the term “irreparable”.
Conclusions: We see that most of the studies on massive tears were actually done to emphasize irreparable tears. Since most of the massive tears are repairable, the quality feature of massive tears, which are in the group that poses a problem, as irreparable rotator cuff tear or massive irreparable rotator cuff tear should be emphasized.
Keywords: Rotator cuff tears, Shoulder, Arthroscopy, Ireparable, Massive
References
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2. Henry P, Wasserstein D, Park S, Dwyer T, Chahal J, Slobogean G, Schemitsch E. Arthroscopic Repair for Chronic Massive Rotator Cuff Tears: A Systematic Review. E.Arthroscopy 2015;31(12):2472-80. https://doi: 10.1016/j.arthro.2015.06.038
3. DeOrio JK, Cofield RH. Results of a second attempt at surgical repair of a failed initial rotator-cuff repair. J Bone Joint Surg Am 1984;66(4):563–7. https://doi.org/10.2106/00004623-198466040- 00011
4. Gerber C, Fuchs B, Hodler J. The results of repair of massive tears of the rotator cuff. J Bone Joint Surg Am 2000;82(4):505–15. https://doi.org/10.2106/00004623-200004000-00006
5. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures. Pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 1994;304:78–83.
6. Burks RT, Tashjian RZ. Should we have a better definition of pseudoparalysis in patients with rotator cuff tears? Arthroscopy 2017;33: 2281–3.
7. Fuchs B, Weishaupt D, Zanetti M, Hodler J, Gerber C. Fatty degeneration of the muscles of the rotator cuff: assessment by computed tomography versus magnetic resonance imaging. J Shoulder Elbow Surg 1999;8:599-605.
8. Omid R, Lee B. Tendon transfers for irreparable rotator cuff tears. A Am Acad Orthop Surg 2013;21:492-501.
9. Patte D. Classification of rotator cuff lesions. Clin Orthop Relat Res 1990;254:81-6
10. Williams MD, Lädermann A, Melis B, Barthelemy R, Walch G. Fatty infiltration of the supraspinatus: a reliability study. J Shoulder Elbow Surg 2009;18:581–7. https://doi:10.1016/j.jse.2008.12.014 28
11. Kissenberth MJ, Rulewicz GJ, Hamilton SC, Bruch HE, Hawkins RJ. A positive tangent sign predicts the repairability of rotator cuff tears. J Shoulder Elbow Surg 2014;23:1023–7. https://doi:10.1016/j. jse.2014.02.014
12. Kim SJ, Kim SH, Lee SK, Seo JW, Chun YM. Arthroscopic repair of massive contracted rotator cuff tears: Aggressive release with anterior and posterior interval slides do not improve cuff healing and integrity. J Bone Joint Surg Am 2013;95:1482-8.
13. Mori D, Funakoshi N, Yamashita F. Arthroscopic surgery of irreparable large or massive rotator cuff tears with lowgrade fatty degeneration of the infraspinatus: Patch autograft procedure versus partial repair procedure. Arthroscopy 2013;29:1911-21.
14. Novi M, Kumar A, Paladini P, Porcellini G, Merolla G. Irreparable rotator cuf tears: challenges and solutions. Orthop Res Rev 2018;10:93–100.
15. Burkhart SS, Denard PJ, Konicek J, Hanypsiak BT. Biomechanical validation of load-sharing rip-stop fixation for the repair of tissue-deficient rotator cuff tears. Am J Sports Med 2014;42: 457–2. https://doi:10.1177/0363546513516602
16. Lo IK, Burkhart SS. Arthroscopic repair of massive, contracted, immobile rotator cuff tears using single and double interval slides: technique and preliminary results. Arthroscopy 2004;20: 22–33. https://doi:10.1016/j.arthro.2003.11.013
17. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Int J Surg 2010;8:336-341.
18. Obremskey WT, Pappas N, Attallah-Wasif E, Tornetta P III, Bhandari M. Level of evidence in ortho- paedic journals. J Bone Joint Surg Am 2005;87:2632-2638.
19. Collin P, Matsumura N, Lädermann A, Denard PJ, Walch G. Relationship between massive chronic rotator cuff tear pattern and loss of active shoulder range of motion. J Shoulder Elbow Surg 2014; 23(8):1195–1202. https://doi:10.1016/j.jse.2013.11.019
20. Dwyer T, Razmjou H, Henry P, Gosselin-Fournier S, Holtby R. Association between pre-operative magnetic resonance imaging and reparability of large and massive rotator cuff tears. Knee Surg Sports Traumatol Arthrosc 2015;23:415-22.
21. Karuppaiah K, Sinha J. Scaffolds in the management of massive rotator cuff tears: current concepts and literature review. EFORT Open Rev 2019; 4:557-566. doi: 10.1302/2058-5241.4.180040
22. Cowling P, Hackney R, Dube B, Grainger AJ, Biglands JD, Stanley M, Song D, Conaghan PG, Kingsbury SR. The use of a synthetic shoulder patch for large and massive rotator cuff tears – a feasibility study. BMC Musculoskelet Disord 2020 ;21:213. doi: 10.1186/s12891-020-03227-z.
23. Duchman KR, Mickelson DT, Little BA, Hash TW, Lemmex DB, Toth AP, Garrigues GE. Graft use in the treatment of large and massive rotator cuff tears: an overview of techniques and modes of failure with MRI correlation. Skeletal Radiol 2019; 48:47-55. doi: 10.1007/s00256-018-3015-4.
24. Lin J, Sun Y, Chen Q, Liu S, Ding Z, Chen J. Outcome Comparison of Graft Bridging and Superior Capsule Reconstruction for Large to Massive Rotator Cuff Tears: A Systematic Review. Am J Sports Med 2020; 48:2828-2838. doi: 10.1177/0363546519889040.
25. Malahias MA, Chytas D, Kostretzis L, Gkiatas I, Kokkineli S, Antonogiannakis E. Arthroscopic anatomic complete versus non-anatomic repair of massive rotator cuff tears: a systematic review of comparative trials. Musculoskelet Surg 2020; 104:145-154. doi: 10.1007/s12306-020-00648-w.
26. Memon M, Kay J, Quick E, Simunovic N, Duong A, Henry P, Ayeni OR. Arthroscopic-Assisted Latissimus Dorsi Tendon Transfer for Massive Rotator Cuff Tears: A Systematic Review. Orthop J Sports Med. 2018; 6:2325967118777735. doi:10.1177/2325967118777735.
27. Ono Y, Herrera DAD, Woodmass JM, Boorman RS, Thornton GM, Lo IKY. Graft Augmentation Versus Bridging for Large to Massive Rotator Cuff Tears: A Systematic Review. Arthroscopy 2017; 33:673-680. doi:10.1016/j.arthro.2016.08.030.
28. Sochacki KR, McCulloch PC, Lintner DM, Harris JD. Superior Capsular Reconstruction for Massive Rotator Cuff Tear Leads to Significant Improvement in Range of Motion and Clinical Outcomes: A Systematic Review. Arthroscopy 2019; 35:1269-77. doi: 10.1016/j.arthro.2018.10.129.
29. Villatte G, Erivan R, Nourissat G, Marcheix PS, Pereira B, Aubret S, Boisgard S, Descamps S. Allograft and autograft provide similar retear rates for the management of large and massive rotator cuff tears: a review and meta-analysis. Knee Surg Sports Traumatol Arthrosc 2022; 30:2039-59. doi:10.1007/s00167-021-06745-y.
30. Piekaar RSM, Bouman ICE, van Kampen PM, van Eijk F, Huijsmans PE. Early promising outcome following arthroscopic implantation of the subacromial balloon spacer for treating massive rotator cuff tear. Musculoskelet Surg. 2018; 102:247-255. doi: 10.1007/s12306-017-0525-5.
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Preoperative Measurement of Screw Nail Length to Make a Template For Surgery to Decrease Radiation Exposure and Surgical Time
/in January-June 2022 | Volume 8 | Issue 1Vol 8 | Issue 1 | January-June 2022 | page: 01-05 | Sanjay Chhawra, Raman Jain, Gaganpreet Singh, Amrit Kumar, Ravi Diresala
DOI: 10.13107/ti.2022.v08i01.021
Authors: Sanjay Chhawra [1], Raman Jain [1], Gaganpreet Singh [1], Amrit Kumar [1], Ravi Diresala [1]
[1] Department of Orthopedics, Jaipur Golden Hospital, Rohini, Delhi, India.
Address of Correspondence
Dr. Sanjay Chhawra
Department of Orthopedics, Jaipur Golden Hospital, Rohini, Delhi, India.
E-mail: sanjaychhawra@yahoo.com
Abstract
Background: Orthopaedic surgeons always stress the need for a proper implant patient match in trauma surgery. The implant incongruity causes discomfort inaccurate load sharing aseptic loosening. The present study was undertaken to get an interpretation of implant size as a template preoperatively to be used to prevent radiation during surgery decrease surgical complications by decreasing surgical time and get abundance availability of implant stock.
Materials and Methods: Qualitative data collection These data were collected from operated cases last 2 years of trauma cases
Results: The coin technique, preoperatively nail measurement, and the average length of the implant was collected to get an interpretation of implant size as template preoperatively to be used in trauma fixation abetted to decrease surgical time and radiation exposure.
Conclusions: Pre-operative measurement making template of intramedullary devices extramedullary devices by coin technique, preoperatively nail measurement and using mean data of operated cases reduces surgical time helped in reducing surgical complication and radiation exposure.
Keywords: Template, Radiation exposure, Implant measurement
References
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2. Hang Cheng, MSc, Jeffrey W. Clymer, PhD, Brian Po-Han Chen, ScM, Behnam Sadeghirad PhD, Nicole C. Ferko, MSc, Chris G. Cameron, PhD, and Piet Hinoul, MD Prolonged operative duration is associated with complications: a systematic review and meta-analysis (http://creativecommons.org/licenses/by-nc-nd/4.0/). https://doi.org/10.1016/j.jss.2018.03.022.
3. P. Blachut Radiation exposure in orthopaedic trauma surgery Orthopaedic Proceedings VOLUME 90-B, ISSUE SUPP_III / AUGUST 2008.
4. Roman A Hayda 1, Raymond Y Hsu, J Mason De Passe, Joseph A Gil Radiation Exposure and Health Risks for Orthopaedic Surgeons DOI: 10.5435/JAAOS-D-16-00342 J Am Acad Orthop Surg 2018 Apr 15;26(8):268-277.
5. Rodica Marinescu, Diana Popescu, Dan Laptoiu A Review on 3D-Printed Templates for Precontouring Fixation Plates in Orthopedic Surgery J. Clin. Med. 2020, 9, 2908; doi:10.3390/jcm9092908.
6. Hansjoerg Heep,1 Jie Xu,2 Christian Löchteken,1 and Christian Wedemeyer1 A simple and convenient method guide to determine the magnification of digital X-rays for preoperative planning in total hip arthroplasty Orthop Rev (Pavia). 2012 Jan 2; 4(1): e12. doi: 10.4081/or. 2012.e12.
7. Accurate scaling of digital radiographs of the pelvis. A prospective trial of two methods S Wimsey 1, R Pickard, G Shaw J Bone Joint Surg Br 2006 Nov;88(11):1508-12. doi: 10.1302/0301-620X.88B11.18017.\
8. Conn KS, Clarke MT, Hallett JP. A simple guide to determine the magnification of radiographs and to improve the accuracy of pre-operative templating. J Bone Joint Surg [Br] 2002;84-B:269-72.
9. Renjit Thomas Issac a, Hitesh Gopalan, Mathew Abraham, Cherian John, Sujith Mathew Issac , Diju Jacob R.T. Issac et al. Preoperative determination of tibial nail length: An anthropometric study / Chinese Journal of Traumatology 19 (2016) 151-155 http://dx.doi.org/10.1016/j.cjtee.2016.03.003.
10. Monappa A Naik,1 Premjit Sujir,1 Sujit Kumar Tripathy,2 Tarun Goyal,3 Sharath K Rao1 Correlation between the forearm plus little finger length and the femoral length Journal of Orthopaedic Surgery 2013;21(2):163-6.
11. Eran Keltz, MD Daniel Dreyfuss, MD Eyal Ginesin, MD Nabil Ghrayeb, MD Nir Hous, MD Nirit Yavnai, DMD, MPH Doron Norman, MD Ido Stahl, MD Preoperative Evaluation of Intramedullary Tibial Nail Measurements—A Review of the Literature and a New Technique Using Contralateral Radiographs and Digital Planning JAAOS Glob Res Rev 2019;3: e015 DOI: 10.5435/ JAAOSGlobal-D-19-00015.
12. Nazir AA, Alazzawi S, Mahur K, Roy WS Estimation of femoral length for intramedullary nail using forearm as reference Orthopaedic Proceedings Vol. 91-B, No. SUPP_I 37.
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Management of Pauwels Type 3 Femur Neck Fracture by Open Reduction Internal Fixation with DHS System and Intertrochanteric Valgus Osteotomy: A Case Series
/in Volume 7 | Issue 2 | July-December 2021Vol 7 | Issue 2 | July-December 2021 | page: 18-21 | Neetin P. Mahajan, Pranay P. Kondewar, Lalkar Gadod, Akshay K. S
DOI-10.13107/ti.2021.v07i02.020
Author: Neetin P. Mahajan [1], Pranay P. Kondewar [1], Lalkar Gadod [1], Akshay K. S [1]
[1] Department of Orthopedics, Grant Government Medical College and Sir J.J Group of Hospital, Mumbai, Maharashtra, India. Address of Correspondence Dr. Pranay Pravin Kondewar, Grant Government Medical College and Sir J. J Group of Hospital, Mumbai, Maharashtra, India. E-mail: pranaypk1@gmail.com
Abstract
Femur neck is anatomically weaker and prone for fractures in all age groups of population.trauma is major cause of fracture in young individuals. Neck of femur fracture are classified based on anatomical location of fracture , pauwels classification system using orientation of fracture line and gardens system based on trabecular alignment in femur head and acetabulum. In young patients open reduction and internal fixation is preferred choice but in elderly we perform arthroplasty. When fracture is more vertical there are chances of non-union due to shear forces across fracture site.In this case series all the patients are having neck of femur fracture pauwels type 3 and are managed with lateral closing wedge valgus osteotomy at level of lesser trochanter to convert shear forces into compression forces which promotes healing of fracture And fixation is done using DHS system and CC screws .all patients were mobilised with Walker by nil weight bearing initially and followed up at 2 weekly interval later gradually weight bearing started as tolerated and all shows union of fracture and osteotomy site at 12 weeks post op. Keywords: Neck of femur fracture, Pauwels type 3, Pauwels angle, DHS system, Valgus osteotomy, Compression forces
References
1.Koval KJ, Zuckerman JD. Hip Fractures: I. Overview and Evaluation and Treatment of Femoral-Neck Fractures. J Am Acad Orthop Surg. 1994 May;2(3):141-149. 2. Barney J, Piuzzi NS, Akhondi H. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 6, 2021. Femoral Head Avascular Necrosis. 3.M.H. Meyers, J.P. Harvey Jr., T.M. Moore Treatment of displaced subcapital and transcervical fractures of the femoral neck by muscle-pedicle-bone graft and internal fixation. A preliminary report on one hundred and fifty cases .J Bone Joint Surg Am, 55 (1973), pp. 257-274 4.Pauwels F. Biomechanics of the normal and diseased hip. Springer Science and Business Media: 1976. 5.Muller ME. Intertrochanteric osteotomy: indications, preoperative planning, technique. Berlin: Springer-Verlag; 1984. pp. 25–66. 6.Chen Z, Wang G, Lin J, Yang T, Fang Y, Liu L, Zhang H. [Efficacy comparison between dynamic hip screw combined with anti-rotation screw and cannulated screw in treating femoral neck fractures]. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Jan;25(1):26-9. Chinese. PMID: 21351604. 7.Bachiller, Fernando Gómez-Castresana MD, PhD*; Caballer, Antonio Perez MD, PhD**; Portal, Luis Ferrández MD, PhD* Avascular Necrosis of the Femoral Head After Femoral Neck Fracture, Clinical Orthopaedics and Related Research: June 2002 – Volume 399 – Issue – p 87-109 8.Calandruccio RA, Anderson WE 3rd. Post-fracture avascular necrosis of the femoral head: correlation of experimental and clinical studies. Clin Orthop Relat Res. 1980 Oct;(152):49-84. PMID: 7438624. 9.N.K. Magu, R. Singh, R. Mittal, et al.Osteosynthesis and primary valgus intertrochanteric osteotomy in displaced intracapsular fracture neck of femur with osteoporosis in adults Injury, 36 (2005), pp. 110-122, 10.1016/j.injury.2004.02.017
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Adult Traumatic Eight Days Old Anterior Dislocation of the Hip with Ipsilateral Fracture Upper Third Shaft Femur: An Atypical Case Report
/in Volume 7 | Issue 2 | July-December 2021Vol 7 | Issue 2 | July-December 2021 | page: 15-17 | Brijesh Sharma, Yajuvendra Kumar Sharma, Rohit Yadav, Chandra Prakash Pal
DOI-10.13107/ti.2021.v07i02.019
Author: Brijesh Sharma [1], Yajuvendra Kumar Sharma [1], Rohit Yadav [1], Chandra Prakash Pal [1]
[1] Department of Orthopaedics, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India.
Address of Correspondence
Dr. Chandra Prakash Pal,
Professor and Head, Department of Orthopaedics, Sarojini Naidu Medical College, Agra, Uttar Pradesh, India.
E-mail: drcportho@gmail.com
Abstract
Introduction: Anterior or posterior dislocation of hip are usually associated with fracture head of femur but dislocations associated with femoral neck, trochanter and shaft are very rare and among this anterior dislocation of hip with ipsilateral fracture of shaft femur is an extremely rare injury. We reported a case of anterior dislocation of hip associated with ipsilateral fracture shaft femur upper third in adult male.
Case presentation: A 25 yrs male, low socioeconomic status was brought to our emergency department was conscious but unable to mobilize his right lower limb and external rotation deformity was present with some shortening. No neurovascular compromise and was found fracture shaft femur along with anterior dislocation of right hip on x-ray and treated by close reduction of femoral head and internal fixation of fracture shaft femur by intramedullary nail.
Conclusion: Early diagnosis of hip dislocation is essential to prevent avascular necrosis of femur head in future. We concluded that there is no need of open reduction for anterior hip dislocation in every such case. Close reduction of anterior dislocation of hip followed by femur interlocking for femoral shaft fracture is good option for management for such type of injuries.
Keywords: Hip dislocation, Close reduction, Avascular necrosis, Fracture dislocation
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