A novel technique of managing an irreducible posteriorly displaced type 2 odontoid fracture: A case report.

Background: Type 2 odontoid fractures with posterior displacement are rare. Most acute cases reported in the literature are readily reduced with traction alone. Here, we reviewed the management of a chronic, posteriorly displaced odontoid fracture that was managed with a unique posterior reduction maneuver. Case Description: A 58-year-old male with a chronic type 2 retro-odontoid displaced fracture was managed with traction and an anterior force applied to the displaced odontoid fragment using rods attached to bilateral C1 lateral mass screws. Notably, this included a simultaneous cantilever maneuver using a lever placed between the C1 and C2 facet joints. Following reduction, an atlantoaxial fusion was performed. The postoperative course of the patient was uneventful and the bone union was achieved in 1 year. Conclusion: Closed reduction is rarely successful in chronic posteriorly displaced type 2 odontoid fractures. These cases require meticulous open reduction and fixation.

Outcome of Joint Aspiration in Acute Knee Haemarthrosis in a Haemophilic Joint: A Prospective Randomised Controlled Trial in 120 Patients in a Tertiary Haemophilia Care Centre.

Background: Bleeding into the joints cause major morbidity in haemophilia patients. The clinical hallmark of haemophilia is haemarthrosis especially in knee, ankle and elbow joint. Current literature suggests that aspiration of an acute haemarthrosis in haemophilia may lead to further bleeding and prevent tamponade effect. But the rehabilitation gets delayed, leading to joint stiffness and the function gets deteriorated. This study was done to evaluate the efficacy of joint aspiration in the management of acute knee haemarthrosis, with regard to pain relief and functional outcome. Materials and Methods: This is a prospective, randomised controlled trial in a tertiary care haemophilia treatment centre comprising 120 haemophilic patients with unilateral acute knee haemarthrosis. Factor level was checked and appropriate factor replacement [40%] was done. The patients were randomly allocated in two groups: Group A and Group B, each consisting of 60 patients. All patients received ice application, limb immobilisation, analgesics, physiotherapy and compression bandage as the routine primary management. In addition, study Group A also received therapeutic aspiration of the knee joint at initial presentation, after the first factor infusion. All patients were clinically evaluated for pain in terms of Visual Analogue Scale (VAS score) and function in terms of Haemophilic Joint Health Score [HJHS], before and at 4 h, 48 h and 7 days after initial factor administration. Results: All patients showed therapeutic improvement in terms of a declining trend in VAS and HJHS scores. Pain relief (VAS Score) in Group A, was found to be significantly better compared to Group B at the end of 4 h [4.80 ± 0.49 vs 6.54 ± 1.05; p < 0.001], 48 h [2.48 ± 0.50 vs 3.30 ± 0.46; p < 0.001] and 7 days [1.16 ± 0.37 vs 1.70 ± 0.46; p < 0.001]. Functional improvement (HJHS Score) in Group A, was found to be significantly better compared to Group B as well at the end of 4 h [11.24 ± 0.77 vs 14.52 ± 0.61; p < 0.001], 48 h [7.24 ± 0.65 vs 11.28 ± 0.64; p < 0.001] and 7 days [2.36 ± 0.48 vs 5.52 ± 0.67; p < 0.001]. Conclusion: Our study recommends the use of joint aspiration as a therapeutic tool in the holistic management of acute knee haemarthrosis in addition to usual treatment of ice application, immobilization and oral tranexamic acid. Early factor replacement along with therapeutic joint aspiration is a key for better pain relief and a better functional outcome.

The influence of joint line restoration on functional outcome after primary total knee arthroplasty: A prospective study.

Objective: Restoration of proper joint line position after primary total knee arthroplasty (TKA) is important for improved knee function and kinematics. We reviewed the magnitude of joint line alteration and the resulting effect on post-operative knee outcomes scores at one year follow-up. Materials and methods: 120 patients who underwent TKA for primary osteoarthritis knee were included. Assessment of joint line position before and after surgery was performed with the help of bony landmarks (excluding osteophytes): Medial Epicondyle Joint Line distance (MEJL), Lateral Epicondyle Joint Line distance (LEJL) and Fibula Head Joint Line distance (FHJL) were calculated. Post-operative knee function was assessed using 'The Western Ontario and McMaster Universities Arthritis Index' (WOMAC) and 'Knee Society Score' (KSS) at one year follow-up. Results: Joint line elevation was observed in 104/120 (86.7%) patients and 16/120 (13.3%) patients had no joint line elevation. The mean joint line elevation was 3.00 (±2.13) mm. The patients were sub-classified into two study groups: Group A- Joint line elevation <5 mm and Group B- Joint line elevation ≥ 5 mm. The mean post-op one-year KSS score was significantly higher in patients in Group A compared to Group B (52.82 ± 7.564 vs. 40.73 ± 7.146; p < 0.001). The mean post-op one-year WOMAC score was lower in patients in Group A compared to Group B (65.51 ± 14.762 vs.75.64 ± 8.203) and the difference was statistically significant (p = 0.002). Conclusion: Elevation of joint line ≥5 mm from the pre-operative value has a negative impact on post-operative functional outcome in primary TKA.

Proximal Thoracic Kyphoscoliosis with Dorsal Myelopathy in a Case of Congenital Absence of Thoracic Pedicles: A Case Report.

CASE: A 14-year-old boy with proximal thoracic kyphoscoliosis associated with the bilateral absence of thoracic pedicles presented with progressive deformity, paraparesis, and difficulty in ambulation. The case was managed by preoperative halo traction, single-stage 2-level vertebral column resection, decompression, and arthrodesis of thoracic vertebrae. Two years postoperatively, the patient showed neurological improvement, leading to unassisted ambulation and fusion at the corpectomy site. CONCLUSION: Preoperative halo-gravity traction restores the sagittal and coronal balance, improves the functional status of the patient, and corrects the deformity to some extent. 3D printed models help in better understanding of osseous anatomy and minimizing intraoperative time.

Management Dilemma of a Neuropathic Knee in a Known Case of Larsen Syndrome: A Case Report.

Introduction: Larsen syndrome (LS) is a rare genetic disorder affecting mainly the connective tissues. It is characterized by characteristic facial anomalies, cervical kyphosis, cardiorespiratory disorders, and multiple joint dislocations. We present a case of a 15-year-old male with unstable neuropathic knee joint instability in a known case of LS. The paucity of literature on the management of this rare condition puts an orthopedician in dilemma regarding the optimal treatment. Case Report: A 15-year-old male, known case of LS, presented to our outpatient department with pain and instability in the right knee for 2 years. Clinically, the patient was having syndromic facies. The diagnosis of LS was confirmed on gene mapping. The right knee was swollen with medial joint line tenderness and restricted flexion. The patient had coronal plane valgus instability. The hypertrophied synovium eroded the articular surface. The radiograph of knee was suggestive of neuropathic arthropathy in fragmentation stage. Conclusion: Orthopedician should be aware of such rare entity with its bony and soft-tissue manifestations. Neuropathic knee is not an absolute contraindication to total knee replacement, especially with advanced prosthesis. Primary arthrodesis to be considered in young adults with instability.