Background / Objective: Proximal disarticulations and amputations remain necessary for selected cases of locally advanced extremity tumors. We describe a modified technique combining suspended limb positioning, simultaneous two-team dissection, and asynchronous vascular ligation, and report outcomes from an initial case series. Methods: Retrospective case series at a single orthopedic oncology referral center including all consecutive patients who underwent the described procedure between 1999 and 2020. Demographic, histologic and perioperative data were collected. The study was approved by the institutional ethics committee (Opinion No. 7.316.148). Results: Eighteen patients were included (11 males, 7 females; mean age 54.4 years, range 13–92). Most common diagnoses were chondrosarcoma (n=7), pleomorphic sarcoma (n=4) and osteosarcoma (n=3). All patients survived at least 30 days postoperatively. The technique was feasible and safe in this series; the combined strategy appeared to improve surgical exposure and hemostatic control, in line with existing reports. Conclusions: Suspended limb positioning with a simultaneous two-team approach and asynchronous vascular ligation is a safe, reproducible, and ergonomically advantageous method for proximal amputations in orthopedic oncology, with potential to optimize operative time and blood loss. Prospective comparative studies are warranted to validate these findings.
Introduction: Infected gap non-union of the femur is a challenging condition, often requiring advanced treatment methods. The Ilizarov technique, using distraction osteogenesis, is an effective solution, promoting bone healing, deformity correction, and limb length restoration without bone grafting. Materials and methods: Between 1990 and 2023, 145 patients with infected femoral non-unions were treated with the Ilizarov technique. Bone transport was used for defects ranging from 2.5 to 27 cm, with no bone grafts. Treat ment outcomes were evaluated based on healing, infection control, and functional recovery. Results: All patients achieved union, with 5 requiring reapplication of the Ilizarov fixator. The average treatment time was 8.5 months, with patients able to bear weight during recovery. Discussion: The Ilizarov technique proved highly effective in managing infected femoral non-unions, offering superior outcomes over traditional methods and enabling functional recovery with minimal complications. Conclusion: The Ilizarov technique is a safe, effective treatment for infected femoral non-unions, achieving successful healing and functional restoration without bone grafting.1,2
Background: Celiac Disease (CD) is an autoimmune, gluten-sensitive enteropathy characterized by intestinal malabsorption and chronic inflammation. Its prevalence is increasing among patients undergoing total joint arthroplasty (TJA). The purpose of this study was to compare medical and surgical complications between patients with and without CD who undergo TJA. Methods: Data from the PearlDiver Mariner 165 database from 2010 to 2022 was retrospectively analyzed to identify patients who underwent either total hip arthroplasty (THA) or total knee arthroplasty (TKA). Two cohorts were created based on CD status, with a 1:5 propensity match ratio for patients with and without CD. Both groups were matched for age, gender, rheumatoid arthritis, Charlson comorbidity index (CCI), smoking status, obesity, diabetes, chronic kidney disease, and joint arthroplasty type. A total of 23,459 patients were included in the study, comprising of 3,959 patients with CD and 19,500 non-Celiac patients. Both groups were evaluated for 90-day medical complications, 90-day readmissions, 2-year implant complications and healthcare reimbursements, using chi-square analysis and multivariate logistic regression analysis. Results: Celiac patients who underwent TJA had significantly increased incidences of deep vein thrombosis (0.58% vs. 0.28%; p=0.003), pulmonary embolism (0.43% vs. 0.24%; p=0.017), myocardial infarction (0.40% vs. 0.18%; p=0.006), and hypoglycemia (0.25% vs. 0.11%; p=0.030) within 90 days post-surgery. Multivariate analysis revealed that CD patients had significantly higher odds of implant complications, including aseptic loosening and revisions, compared to non-CD patients. Conclusion: This retrospective study found that CD is associated with increased thromboembolic and other postoperative complications following TJA. Therefore, tailored postoperative management strategies, including a modified anticoagulant prophylaxis protocol, are needed for Celiac patients undergoing TJA to better manage these risks and improve patient outcomes.
Introduction: Shoulder arthroplasty (SA) is one of the most common joint replacement surgeries performed and its utilization continues to rise. Inflammatory Bowel Disease (IBD) is associated with decreased bone mineral density and increased risk of fractures. However, the literature remains divided whether IBD contributes to a heightened risk of postoperative complications. This study examines the potential impact of IBD on the incidence of postoperative infections following shoulder arthroplasty. Methods: We analyzed data from the PearlDiver Mariner 165 database from January 1, 2010, to October 31, 2022. Patients who underwent total or reverse shoulder arthroplasty were identified and categorized into two groups, those with IBD and those without, using a 1:5 propensity score-matching approach. Matching was based on demographic data and infection-related comorbidities. Surgical site infections (SSIs) and hospital readmissions were measured at 90-days postoperatively. Surgical complications, including need for revision surgery, prosthetic joint infection (PJI), instability, and aseptic loosening, were recorded up to 2-years following the procedure. Chi-square tests and multivariate logistic regression using odds ratio analysis were performed, with the significance level (α) set at 0.05. Results: The cohort comprised 5,647 IBD patients and 28,177 propensity-matched non-IBD controls, with comparable demographic and comorbidity profiles. There was a statistically significant increase in 90-day readmissions and 2-year SSIs among IBD patients. Similarly, 2-year postsurgical complications, including SSI, PJI, and aseptic loosening, were greater in the IBD group. Conclusion: IBD is a significant risk factor for increased postoperative infection rates in shoulder arthroplasty patients. Although readmission rates are similar at the 2-year mark, along with other post-op complications, further study is needed to understand how medical treatment for IBD can impact the infection rates on SA.
Rationale: There are very few cases of emphysematous osteomyelitis documented in the literature, and it is one of the rare diseases brought on by gas-forming bacteria. Patient concerns: A 63-year-old male was admitted to the orthopaedics ward with the chief complaints of fever and low back pain for one week and shortness of breath for three days. He was a known case of old pulmonary tuberculosis with chronic obstructive pulmonary disease (COPD) and pulmonary artery hypertension (PAH). Diagnoses and interventions: On CT scan, multiple air pockets were noted in L4 & L5 vertebrae. After a CT scan, a probable diagnosis of emphysematous osteomyelitis was made and empirically, antibiotics were started. Fine needle aspiration under CT-guided cytology was done, and Klebsiella pneumoniae was identified based on culture and sensitivity. After confirmation, specific antibiotics were started, and he improved gradually. The patient had a significant improvement in back pain after the treatment.
Bertolotti Syndrome, one of the reasons for lower back pain, is defined by transitional vertebra, scoliosis, and sciatica, and often treated with conservative therapy or rare surgical resection. We present a case of Bertolotti Syndrome with intermittent and recurring low back pain. The pain, observed as a distinct pseudo-joint, was identified by skeletal scintigraphy, showing significant therapeutic success without recurrence after a steroid injection. In the presence of Bertolotti Syndrome, skeletal scintigraphy, pinpointing the high intensity of pain localization, would be a feasible diagnostic approach.
Erb’s palsy is the most common form of obstetrical brachial plexus palsy. The infant’s upper extremity hangs floppily from the shoulder with flexion of the wrist and fingers due to paralysis of muscles innervated by C5 and C6 cervical nerve roots. Lack of long term studies fails to delineate the natural course of the disease. Erb’s palsy has better prognosis than complete brachial plexus palsy. Timely intervention results in good functional recovery. The case presented here not only highlights rarity of the lesion but also its delayed presentation to the clinician and its difficult diagnosis and henceforth consequent overlook on the part of parents and clinician, especially in developing countries.
Introduction: Closed distal third tibia fractures are common injuries in South Africa, where there is a high incidence of pedestrian and motor vehicle accidents. The surgical options of treating these fractures include intramedullary nail (IMN), open reduction and locking plate fixation, tibial cannulated screw fixation with fibular plating, and external fixation. We undertook the study to review the radiologic outcomes of closed extraarticular fractures treated surgically with intramedullary nailing or anatomical locking plate. Methods: This was a retrospective cohort study of patients with distal tibial extraarticular fractures treated surgically with intramedullary nail or anatomical locking plate fixation. Data was collected from hospital records over a 24-month period. The radiological evaluation and measurements were made on Picture Archiving and Communication System (PACS). Results: A total of 100 patients were included in the study. Most of the patients were males 61 (61%) patients were male. The age range of patients was 18 years to 77 years (median 38yrs). Eighty patients (80%) were treated with intramedullary nailing and those treated with plating were 20 (20%). The immediate post-operative anteroposterior (AP) view showed that 73 participants had an acceptable alignment, and 27 patients had malalignment. Lateral view showed that 98 participants had acceptable alignment (98%), with malalignment in only two patients (2%). The RUST score showed 96% (n=96) of the patients had union, and 4% (n=4) had non-union. At the final follow up at 9 months, one patient that initially had good alignment ended up with malunion. Four patients had non-union - one was amputated and three had revisions. Of the four patients that had non-union, three were fixed with anterolateral plate and one treated with IMN. In the 28 patients that had malunion, 26 were treated with intramedullary nailing and two with anterolateral plate. IMN had 32.5% (26/80) malunion rate, plating had 10% (2/20) malunion rate. The methods of fixation were statistically significant (p-value 0.045) in malunion outcomes, with IMN having a higher malunion rate. Plating resulted in a significantly higher rate of nonunion of 15% compared to 1.3% after IMN (p-value 0.005.) Conclusion: Intramedullary nail treatment results in significantly higher malunion rate as compared to locking plate fixation. Plate fixation leads to significantly higher non-union rate compared to intramedullary nail fixation. These methods of fixations were statistically significant in outcomes of malunion and nonunion. More careful consideration is recommended intra-operatively when intramedullary nailing is done, to avoid malalignment. Plating should be recommended only when IMN is contraindicated because of the risk of non-union.
The scaphoid is the most commonly fractured bone among the carpal bones in orthopedic practice. While many fractures heal successfully, some develop nonunion despite appropriate treatment, leading to complications if left untreated. Displaced scaphoid nonunions (SNUs) should be reduced and fixed to prevent further degenerative changes, even when asymptomatic. Various treatments, including percutaneous fixation with a k-wire or screw and open reduction with or without bone grafting, have been described, but no single method has emerged as the gold standard. This study examines the use of the Ilizarov method in treating scaphoid nonunion in 12 patients at the Bari-Ilizarov Ortho-paedic Centre from 1990 to 2024. The Ilizarov technique, involving a three -stage process of distraction, compression, and immobilization, was applied. The outcomes, including healing time, complications, and wrist function, were evaluated. Results showed significant improvements in bone healing, pain reduction, and wrist function, though range of motion did not significantly change. The Ilizarov method proves to be an effective treatment for scaphoid nonunion, especially in cases without carpal collapse or avascular necrosis, and further research is needed to compare it with other treatment options.
Introduction: The term "phlebitis-like" syndrome or pseudothrombophlebitis represents a real diagnostic challenge for the clinician, especially in the elderly subject. It may be secondary to a popliteal cyst, focal myositis, or a disrupted popliteal aneurysm in the calf. We present a case of pseudothrombophlebitis secondary to a broken Baker's cyst in an elderly patient with rheumatoid arthritis (RA). Observations: A 60-year-old patient, followed for peripheral hypothyroidism related to Hashimoto's thyroiditis and a well-balanced seropositive RA under disease-modifying antirheumatic drugs (DMARDs) and hormone replacement therapy. She was referred urgently for suspicion of lower limb phlebitis: acute pain with swelling of the right calf with increased calf perimeter, local inflammatory signs and a positive Homans sign. Doppler ultrasound showed no thrombophlebitis but objectified a right popliteal cyst ruptured in the calf. Under oral and topical anti-inflammatory treatment, the evolution was favorable. Conclusion: The ruptured Baker cyst deserves to be known and evoked as possible diagnosis of a large acute leg simulating phlebitis, especially in aged person with RA, because the therapeutic implications are totally different.
Introduction: Hip fracture involves fracture of the femoral neck, intertrochanteric and subtrochanteric fractures. There have been controversies in the choice for the best fixation method for the various forms of hip fractures. Among the options, dynamic hip screw (DHS) offers fast and stable fixation with acceptable complication rates. The study aimed to share our experience with using DHS as a fixation method for adult hip fractures in our centre. Methods: This is a retrospective study of 121 adult patients who had DHS screw fixations for proximal femoral fractures from June 2015 to May 2018 at Orthopaedic Hospital Wamakko, Sokoto, North-western region of Nigeria. Results: There were 95 (79%) males and 26 (21%) females with a mean age of 51 years (range 18 to 95 years). Right-sided fracture occurred in 67 (55%) patients and the left-sided in 54 (45%) patients. Seventy-two patients (60%) had road traffic accident (RTA), 38(31%) patients had falls, nine (7%) had sports injuries, and 2 (2%) had assaults. Seventy-two (60%) patients sustained intertrochanteric fractures, 38 (31%) femoral neck fractures, and 11 (9%) subtrochanteric fractures. The longest duration of presentation and average waiting time before surgery were 3 to 4 weeks in 11(9%) patients and 5 days respectively. Forty-three (35%) patients had open reduction and the longest surgery time was an average 2.1 hours. The average follow-up period was 2.6 years, and the subjective clinical outcomes at 6 months follow-up were 76(63%) excellent, 26 (21%) good, 11 (9%) fair, and 8 (7%) poor results. The mean Parker mobility score for the 114 patients was 6.1 before the injury and 4.3 at 1 year follow-up. Postoperative complications were 4 (3.3%) non-union, 3 (2.5%) screw cut-outs, 3 (2.5%) AVN, 3 (2.5%) Limb length discrepancy of greater than 2cm, 2 (1.7%) implant infections, 2 (1.7%) Coxa vara, and 2 (1.7%) hip osteoarthritis. Conclusion: The use of DHS fixation devices for hip fractures in adults generally has good outcomes when appropriately indicated in patients with early presentation.
Comminuted fractures and fracture-dislocations of the talus present significant challenges in orthopedic trauma, often leading to complications such as osteonecrosis that can severely impact long-term outcomes. This study evaluates the effectiveness of the Blair fusion with Ilizarov technique in managing these complex injuries. Effective primary management and close monitoring for potential complications, particularly in displaced fractures, were prioritized. Utilizing anteroposterior radiographs at 6-8 weeks post-injury allowed for early recognition of osteonecrosis through the Hawkins sign. Surgical intervention involved excising necrotic talus tissue and performing Blair fusion with Ilizarov fixator. Results indicated significant anatomical restoration without limb shortening, high rates of arthrodesis, and preserved functional mobility at the subtalar joint
Methotrexate (MTX) is used as a disease-modifying anti-rheumatic drug (DMARD) in the treatment of rheumatoid arthritis due to its strong efficacy and tolerability.1 MTX has a wide range of side effects including bone marrow suppression, hepatic or renal dysfunction, gastrointestinal, mucocutaneous damage and neurotoxicity.2 Serious side effects and toxicity occur, especially if the dose is mistakenly used daily. However, mtx is normally used weekly Age, drug interaction, individual sensitivity and comorbidities may contribute to the development of toxicity.3 Regular monitoring and selection of patients for the use of MTX medication, appropriate counselling on drug interactions, instructions on side-effects are necessary to prevent such complications. We presented our case on the development of toxicity table as a result of daily use of MTX in RA treatment.
Schmorl’s node is formed when the nucleus pulposus of an intervertebral disc herniates upward or downward an adjacent vertebral endplate or subchondral trabeculae. Some Schmorl’s nodes may present as big cystic lesions, differing significantly from the typical form. This study reports a rare case of Schmorl’s node with cavitation, a presentation distinct from both classic and cystic Schmorl’s nodes. We present a case of a 44-year-old male with neck pain and restricted cervical motion, whose skeletal scintigraphy showed a cavitated Schmorl’s node, which might be caused by upward nucleus pulposus of the intravertebral disc into a cervical vertebra, presumed by magnetic resonance images. This report describes a rare case of cavitated Schmorl’s node and highlights its unique imaging characteristics. It demonstrates that conservative treatment can be an effective approach for managing cavitated Schmorl’s nodes.
Cardiovascular diseases (CVD) interpretation for 27.93% of entirely demises trendy Bangladesh. Foremost risk factors for CVD contain age, gender, heredity, hypertension, cigarette smoking, hypercholesterolemia, diabetes, obesity and physical dormancy. The recent study was steered to appreciate the knowledge, attitude and practice (KAP) of younger adults regarding cardiovascular diseases. This is a cross-sectional study exhausting a convenience sampling technique. The sample size was 55. KAP questionnaire remained advanced formerly scattered to the respondents involved. The data composed stood scrutinized using SPSS version 22.0. The mean and standard deviation of the knowledge, attitude and practice grooves were 37.89±5.811. Substantial difference on knowledge marks stood create amongst diverse risk factors (p<0.001), also on attitude and practice nicks in comparison amongst altered genders (p = 0.005 and 0.017, correspondingly). This study also shows a momentous constructive association between attitude and practice nicks (r=+0.354, p<0.001). Are you conscious of record useful method for retrieval this study showed that physiotherapy participants were chief rate that was 41.8% (n=23) and both participants were 40% (n=22) and medication were 18.2% (n=10). In this research should recommend and inspire in exercise further and ripen a healthier lifestyle.
Background: Radioulnar synostosis is a rare congenital condition characterized by abnormal fusion of the radius and ulna, leading to restricted forearm rotation and limitations in daily activities. Early diagnosis and appropriate surgical intervention are crucial for improving functional outcomes, yet the optimal treatment approach remains controversial due to limited evidence. This study aims to present a unilateral proximal radioulnar synostosis case in an 8-year-old patient, detailing the surgical management and postoperative results to contribute to the existing literature on effective treatment strategies. Case presentation: An 8-year-old patient presented with unilateral proximal radioulnar synostosis diagnosed at the age of two. The patient exhibited significant limitations in daily activities, scoring 6 points (poor) on the Failla functional scale and classified as grade III according to the Cleary and Omer radiological classification. Surgical resection of the synostosis via osteotomy was performed, followed by immobilization with a cast for six weeks. Rehabilitation commenced after cast removal, focusing on improving supination and overall limb function. The postoperative evaluation showed marked improvement, with the patient achieving 12 points (good) on the Failla scale and increased range of supination. Conclusion: This case highlights the importance of timely diagnosis and intervention in radioulnar synostosis. Adequate physical examination and imaging studies enable early treatment, which can significantly improve the functional prognosis in affected patients. The successful outcome in this patient suggests that surgical resection combined with rehabilitation is an effective treatment modality for this rare condition
