We are reporting a case of post traumatic chronic osteomyelitis of the tibia with an open wound exposing an intra medullar nail implant for 13 years. The patient presented with fresh ipsilateral tibia plateau fracture. He was treated by removal of the implant, debridement and local placement of Gentamicin impregnated PMMA beads according to guidelines of the two stage Belfast technique. After five months of wound treatment, the exposed bone was covered by healthy granulation tissue and the patient was able to fully bear weight.
orthopaedic

Dynamic hip screw (DHS) fixation is considered standard treatment for most intertrochanteric fractures. However, excessive sliding at the fracture site and medialisation of femoral shaft may lead in fixation failure. In contrast, fixedangled 95 condylar blade plate (CBP) has no effective dynamic capacity and causes little bone loss compared to DHS. We compared the outcome of 57consecutive unstable intertrochanteric fragility fractures treated with these two fixation methods. CBP instrumentation is more difficult requiring longer incision, operating time and higher surgeonreported operative difficulty. The six month post operative mortality rate is 16%. Post operative Harris hip scores were comparable between the two methods. Limb length shortening more than 20 mm was 6 fold more common with DHS. In elderly patients with unstable intertrochanteric fragility fractures, fixed angled condylar blade plate appears to be a better choice than dynamic hip screws for preventing fixation failures.
orthopaedic

This study was conducted to evaluate the efficacy of intraarticular injection of hyaluronic acid for the treatment of knee osteoarthritis. Patients with knee osteoarthritis were followed for a period of six months to assess the efficacy of intra articular injection of hyaluronic acid given three times in three consecutive weeks. Fifty patients were reviewed at two, eight and 24 weeks post injection. The average age was 60.9 years and female to male ratio was 3:1. Patients were assessed using the Lequesne Algofunctional Index for function, and the visual analogue score for pain and side effects. We found that the knee pain reduced and the function improved in most patients and these beneficial effects maintain till the last follow up. The only side effect noted was one case of acute non septic joint effusion after the 3rd injection. We concluded that intra articular injection of hyaluronic acid can produce pain relief and functional improvement for up to 6 months.
orthopaedic

Necrotizing fasciitis is a life and limb threatening soft tissue infection with a high mortality rate. This study tries to identify the possible risk factors that contribute to mortality in patients with necrotizing fasciitis involving a lower limb. We prospectively reviewed 41 patients that presented with necrotizing fasciitis of the lower limb over a period of one year. Results show that the mortality rate for necrotizing fasciitis of the lower limb is quite high at 19.5%. Comparison among necrotizing fasciitis patients reveals that higher mortality rate is seen among those patients with advanced age and those presented with initial high pre operative creatinine levels. Sex, pre morbid diabetes mellitus, duration from initial symptoms to presentation for treatment and presence of streptococcus group A were not associated with an increased mortality rate. Neither were admission vital signs, subcutaneous gas on radiograph, prior antibiotic treatment on admission or clinical note of bullae formation.
orthopaedic

Extensive peri acetabular osteolysis caused by malignant disease process is a major surgical challenge as conventional hip arthroplasty is not adequate. We describe a modified use of the Harrington procedure for acetabular insufficiency secondary to metastatic disease in twelve patients. The procedures include application of multiple threaded pins to bridge the acetabular columns, anti protrusio cage and cemented acetabular cup. Eleven patients were able to walk pain free and achieved a mean Musculoskeletal Tumour Society Functional Score of 80 (range, 68 to 86).
orthopaedic

Adolescent idiopathic scoliosis is a spinal deformity that affects patients self image and confidence. Surgery is offered when the curvature is greater than 50 degrees based on the likelihood of curvature progression. Outcome measures for scoliosis correction can be described in terms of radiological improvement or improvement of health related quality of life scores. The Scoliosis Research Society 22 (SRS 22) and Scoliosis Research Society 24 (SRS 24) questionnaires are widely accepted and used to characterize clinical results. Therefore, this prospective study of 38 patients aims to investigate how the SRS 24 and SRS 22 questionnaires compare to each other in terms of scoring when the same group of patients is evaluated. The SRS 22 questionnaire tends to give an inflated value in the overall score, pain and self image domain compared to the SRS 24 questionnaire.
orthopaedic

We studied the effect of the addition of the bacteriostatic agent, netilmycin, to cefotiam treatment as prophylactic antibiotics against infection for grade III open tibial fractures. From 45 eligible cases, assigned randomly to a control group that receive only cefotiam, and the treatment group that receive netilmycin in addition to cefotiam. We observed that the clearing of infection occurred earlier in the cefotiam /netilmycin group. We found that 3 day administration of cefotiam netilmycin is superior to 3 day administration of cefotiam only. It is equivalent to 5 day treatment with cefotiam alone.
orthopaedic

Selective cervical nerve root injection using a mixture of corticosteroid and lignocaine is a treatment option for managing cervical radiculopathic pain. The procedure is usually performed under image guided fluoroscopy or Computerized Tomograhy. Ultrasound guided cervical nerve root block does not expose the patients and personnel to radiation. During injection, the fluid is mostly visualized in a real time fashion. This retrospective study reviewed the effectiveness of ultrasound in guiding cervical peri radicular injection for pain relief in patients with recalcitrant cervical radiculopathy. There were no complications reported in this series.
orthopaedic

Forearm deformity secondary to giant solitary ulna exostosis is rare. We describe a rare presentation of symptomatic solitary giant exostosis involving the entire distal ulna resulting in ulnar bowing of the forearm in a five year old boy. The tumour was completely resected and the defect was reconstructed with an allograft wrapped with a free autogenous periosteal tubular sleeve to deliver fresh pluripotential cells for better incorporation and integration. The distal ulna physes was preserved. An osteotomy was performed on the radius to correct the deformity. One year after surgery, the deformity remains corrected with normal bone length and excellent hand function. There is no evidence of local recurrence and the allograft has fully incorporated.
orthopaedic ; ; ;

Removal of plates is a procedure commonly performed by orthopaedic surgeons and stripped screws are probably the most common problem encountered during this procedure. Stripped screws are caused by slippage between the screwdriver and the screw. Due to the inherent difficulty in removing such screws, surgeons should be knowledgeable in techniques for their removal and should be equipped with the proper instruments to expedite the procedure. There are few published articles about such techniques. This report describes a technique for removal of plates with stripped screws. The tip of a stripped screw is approached from the far cortex and then reamed with a trephine reamer in the direction of the screw until both cortices are cleared. The plate is then removed with stripped screws attached. All the removals utilizing this technique to date have been successful with no complications, and this method is safe, efficient and technically easy to learn.
orthopaedic