Frontal Bone Osteomyelitis in Adult.

Frontal bone osteomyelitis is a rare clinical disease which occurs as a result of frontal sinusitis, penetrating injury on head, post-operative complication after sinus surgery and hematogenous spread from distant site. Early diagnosis, appropriate surgical debridement and antibiotic are keys to prevent from life threatening intracranial complications. We report a 63 years old male patient with osteomyelitis of outer cortex of frontal bone. The wound was thoroughly debrided after computer tomography scan showed an osteolytic lesion on outer table of fontal bone and antibiotic was continued for 2 months until inflammatory markers become normal. Keywords: Frontal bone; Intracranial complications; osteomyelitis; pott's puffy tumour.

Comparative study between intramedullary interlocking nailing and minimally invasive percutaneous plate osteosynthesis for distal tibia extra-articular fractures.

PURPOSE: Treatment of distal tibia fractures poses significant challenge to orthopedic surgeon because of poor blood supply and paucity of soft tissue coverage. There is considerable controversy regarding the superior option of treatment for distal tibia fracture between the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique and intramedullary interlocking (IMIL) nailing for extra-articular distal tibia fractures. The aim of our study is to compare the functional outcome between the two treatment methods. METHODS: This was the prospective comparative study of 100 patients with distal third tibia fractures divided into two groups. The first group of patients were treated with MIPPO technique while the second group of patients were managed by IMIL nailing. Patients were followed up in outpatient department to assess the functional outcomes, malunion, delayed union, nonunion, superficial and deep infection between the two groups. Statistical analyses were performed using the SPSS software (version 16.0). RESULTS: Average malunion (degrees) in the MIPPO group was 5 (3-7) ± 1.41 vs. 10.22 (8-14) ± 2.04 in the IMIL group (p = 0.001). Similarly postoperative knee pain in the IMIL group was 10% vs. 2% in the MIPPO group (p = 0.001). In terms of superficial infection and nonunion, the results were 8% vs. 4% and 2% vs. 6% for the MIPPO and IMIL group, respectively (p = 0.001). CONCLUSION: Both procedures have shown the reliable method of fixation for distal extra-articular tibia fractures preserving the soft tissue, bony vascularity and fracture hematoma that provide a favourable biological environment for fracture healing. Considering the results of the study, we have slightly more preference for the MIPPO technique.

Comparative Study between the Precontoured Anatomical Locking Plate and Clavicle Brace for Displaced Mid-Shaft Clavicle Fractures.

BACKGROUND: Most of the midshaft clavicle fractures heal conservatively without further complications with union rate of 94 to 99.7%. Several recent studies recommend surgery for displaced midshaft fracture, to reduce risk of non-union malunion and clavicle shortening. So there is still dilemma for the optimal treatment for displaced midshaft clavicle fracture. METHODS: This was the prospective comparative study performed in Civil Service Hospital, Nepal. Patients were divided into the two groups each containing 40 patients and were treated with figure of eight brace for group 1while group 2 patients were treated surgically. RESULTS: Mean time to unite the fracture was 11.87±1.78 versus 11.55±1.46 weeks (P value 0.37). There were 14 (35%) cases of malunion more than 10 degree in group 1 and 1 (2.5%) malunion in group 2 (P value 0.001). Twenty nine (72.5%) patients in group 1 and 35 (87.5%) in group 2 were fully satisfied one year after treatment Constant and Murley score in group 1 were 75.22±2.85, 90.87±3.39 and 96.30±1.80 at the time of fracture union, six month and one year after surgery while that score in group 2 were 81.67±2.86, 93.87±2.17, 98.20±1.20 respectively ( P value <0.001). CONCLUSIONS: There is higher incidence of nonunion, symptomatic malunion and inferior perception of satisfaction in conservatively treated patients. Functional outcomes are comparable one year after surgery, however it is significantly better in operative group before that.

Bilateral Simultaneous Total Knee Arthroplasty in Elderly Patients with Severe Osteoarthritis of Knee Joint in a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Total knee arthroplasty is one of the most successful orthopedic surgeries performed in recent decades. However, there are controversies regarding the simultaneous or staged bilateral total knee arthroplasty. The aim of this study is to find the prevalence of bilateral total knee arthroplasty in elderly patients among severe osteoarthritis of knee joints in a tertiary care hospital. METHODS: This is a descriptive cross-sectional study conducted from hospital records of 2015 to 2019 in elderly patients with severe osteoarthritis in a Tertiary Care Hospital. Ethical clearance (20/2020) was taken from Institutional Review Board. Convenience sampling was used and statistical analyses were performed using the Statistical Package for the Social Sciences software (version 16.0). Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 1200 patients with severe osteoarthritis, the prevalence of bilateral total knee arthroplasty was found to be 80 (6.67%) (95% Confidence Interval = 6.60-6.74). The mean Knee Society Score was 36±3.70 preoperatively. There were 21 (26.2%) patients having hypertension, 17 (21.2%) diabetes mellitus, 14 (17.5%) chronic obstructive pulmonary disease and 7 (8.7%) coronary artery disease. CONCLUSIONS: Bilateral simultaneous total knee arthroplasty was required in less patients with severe osteoarthritis of knee joints. Bilateral simultaneous total knee arthroplasty is safe, convenient, effective with early functional recovery, higher patient satisfaction and cost effective with acceptable cardiac, pulmonary and neurological complications in properly selected patients.

Isolated Medial Dislocation of Elbow: A Case Report.

Even though posterior or postero-lateral dislocations of elbow are more common, both isolated medial and lateral dislocations of elbow are extremely uncommon. Since there are subtle findings and minimum pain after medial dislocation of elbow, these are sometimes missed by attending physician at first presentation and changes into chronic type with guarded prognosis. We report a case of a 15-year old boy with isolated medial dislocation of elbow which was correctly identified and treated with closed reduction and posterior slab application. Flexion extension as well as supination pronation of elbow 3 months after injury was nearly normal.

Total Knee Arthroplasty in Moderate to Severe Fixed Flexion Deformity in a Tertiary Care Center: A Descriptive Cross-sectional Study.

INTRODUCTION: Performing the total knee arthroplasty in moderate to severe fixed flexion deformity, appropriate resection of bone from distal femur along with proper ligament balancing is mandatory in order to get the reasonable intraoperative correction. The aim of our study is to find out the prevalence of total knee arthroplasty among knees with moderate to severe fixed flexion deformity in a tertiary care center. METHODS: This is a descriptive cross-sectional study conducted from hospital records of 2013 to 2019 in elderly patients with moderate to severe fixed flexion deformity in a Tertiary Care Hospital. Ethical clearance (14/2020) was taken from Institutional Review Board. Convenience sampling was used and statistical analyses were performed using the Statistical Package for the Social Sciences software (version 16.0). Point estimate at 95% confidence interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 400 knees with moderate to severe fixed flexion deformity, the prevalence of total knee arthroplasty was found to be 80 knees (20%) (16.08-23.92 at 95% Confidence Interval). CONCLUSIONS: The prevalence of total knee arthroplasty is comparable to other study. In our study total knee arthroplasty can be performed successfully with excellent functional outcomes in patients with moderate to severe fixed flexion deformity of knee joint provided the joint stability is maintained by appropriate ligamentous balancing.