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.

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.

Open Reduction of Neglected Knee Dislocation: Case Report of a Rare Injury

Old neglected dislocation of knee joint is a rare injury. Any orthopaedic surgeon would have faced only a few cases of unreduced neglected dislocation in his life time practice. We report the case of a 30-year old male patient with one month old unreduced knee dislocation which was managed with open reduction and stabilization with two intra-articular crossed Steinman pins for six weeks, followed by removal of the pins and gradual weight bearing in hinged knee brace. At the end of one year, range of movement of knee joint was 0 to 50 degree with minimal knee pain on walking.