Clinical, MRI and arthroscopic correlation in internal derangement of knee.

BACKGROUND: The traumatic or degenerative internal derangement of the knee requires certain investigations for the establishment of diagnosis, in addition to clinical history and a thorough physical examination. The use of arthrography and arthroscopy improves the accuracy of the diagnosis. MRI scanning of the knee joint has often been regarded as the noninvasive alternative to diagnostic arthroscopy. OBJECTIVE: The purpose of the study was to correlate clinical and low field MRI findings with arthroscopy in internal derangement of the knee. METHODS: Forty one patients with suspected internal derangement of the knee were subjected to MR examination followed by arthroscopy. Clinical criteria used were history, mode of injury, Mc Murray, Apley grinding, Thessaly test for meniscal injury. Drawer test was considered to be essential for clinical diagnosis of cruciate ligament injury. MRI of the knee was performed in low field open magnet (0.35T, Magnetom C, Seimens). Arthroscopy was done within two months of MR examination and was considered gold standard for the internal derangement of the knee. RESULTS: The sensitivity, specificity, diagnostic accuracy of clinical examination were 96.1%, 33.3% and 73.1% respectively for medial meniscal tear; 38.4%, 96.4% and 78.1% respectively for lateral meniscal tear. The sensitivity, specificity, diagnostic accuracy of MRI were 92.3%,100% and 95.1% for medial meniscal tear; 84.6%96.4% and 92.6% respectively for lateral meniscal tear. CONCLUSION: Clinical examination showed higher sensitivity for medial meniscal tear compared to MRI, however with low specificity and diagnostic accuracy. Low field MRI showed high sensitivity, specificity, diagnostic accuracy for meniscal and cruciate ligament injury, in addition to associated derangement like articular cartilage damage, synovial thickening.

Results of simultaneous open reduction and Salter innominate osteotomy for developmental dysplasia of the hip.

OBJECTIVES: To assess the results of simultaneous open reduction and Salter Innominate Osteotomy for developmental dysplasia of the hip in our context where there is a tendency for these cases to present late without having undergone any treatment previously. MATERIAL AND METHOD: We retrospectively reviewed the record files and radiographs of 22 dislocated hips of 20 patients managed with simultaneous open reduction and Salter osteotomy at Hospital and Rehabilitation Centre for Disabled Children from 1999 to 2001. Only eight patients with 9 hips with purely developmental dysplasia of hip aged one to seven years were included. The acetabular index on the initial and final radiographs was measured. The neck shaft angle was also measured. All radiographs were evaluated to determine the presence of avascular necrosis of the femoral head and position of the head after the operation. Clinical results were determined using modification of the McKay criteria (Pain, ROM, LLD, Containtment and Gait) . Follow-up ranged from a minimum of 1 year to a maximum of 5 years (average 3 years and 1 month). RESULTS: The results were excellent in 7 hips (77.77%) good in 1 hip (11.11%) and poor in 1 hip (11.11%) according to modified McKay criteria.. No complications related to infection, graft fracture, vascular or neural injury were encountered. CONCLUSION: When case selection for surgical treatment is appropriate, a reasonable excellent to good result can be expected even in cases such as ours which present late.

Radial club hand deformity--the continuing challenges and controversies.

The records of 27 patients with Radial club hand deformity attending the Hospital and Rehabilitation Centre for Disabled Children (HRDC) were reviewed. This longitudinal intercalary deficiency of forearm growth has a varied clinical presentation and the goals of management are both improved function and cosmesis. We present the results of our treatment and review the current world literature on this challenging orthopaedic deformity.

Surgical interventions in chronic osteomyelitis.

Chronic osteomyelitis is a leading cause of morbidity in orthopaedic practice in Nepal. Various factors like health service inaccessibility, inadequate treatment, malnutrition, poverty, and to some extent antibiotic resistance contribute to disease progression from acute osteomyelitis to chronic osteomyelitis in this region of the world. This paper presents our experience of managing ninety patients with chronic osteomyelitis over a period of four years, from February 1998 to November 2001.

Tibial plateau fractures: four years review at B & B Hospital.

BACKGROUND: Tibial plateau fractures involve the articular surface of the tibia resulting from a combination of axial loading with varus or valgus stress. Inadequate and inappropriate treatment may result in significant functional loss. OBJECTIVE: The purpose of this study was to determine the outcome of our treatment modalities and to compare with the results of comparable studies. METHODS: The results of treatment of 81 knees were reviewed over the period of five years (1997 to 2002). There were 62 men and 18 women, with an average age of 37 years (15 years to 75 years) at the time of initial evaluation. One patient had bilateral involvement. Fractures were classified according to Schatzker. Seven patients were treated conservatively. Sixteen patients (17 knees, one had bilateral involvement) were operated with closed reduction and percutaneous cannulated screws fixation. Thirty one patients' required open reduction and internal fixation with cannulated screws. Fifteen fractures were plated, and in eleven cases, external fixators were used. Follow up period ranged from six months to three years. RESULTS: Results were graded as excellent, good, fair and poor on the basis of functional outcome. Forty three (54%) patients (44 knees) had excellent, twenty two (26%) had good, five (6%) had fair and ten (14%) had poor results. Poor results were associated with high energy fractures, late presentation, and inadequate physiotherapy follow up. Eight patients (10%) had complications. One had common peroneal nerve palsy, six had wound infection and one patient demonstrated early arthritic changes. CONCLUSION: Tibial plateau fracture is a challenging fracture to manage. Restoration of articular congruity and early range of motion should be the primary goal. Proper and adequate preoperative planning is mandatory. Well maintained articular congruity with stable fixation helps early mobilization and better functional outcome.