Search

Purpose. To assess outcomes of minimally invasive plate osteosynthesis (MIPO) using a locking compression plate (LCP) for 42 humeral shaft fractures. Methods. 28 men and 14 women aged 18 to 68 (mean, 34; median, 29) years underwent closed reduction and MIPO using a LCP for type 12-A (n=26) and type 12-B (n=16) humeral shaft fractures. Eight of the patients were aged ≥50 years. Patients were followed up monthly until radiological union in at least 3 of the 4 cortices. Functional assessment was based on the Disabilities of Arm, Shoulder and Hand (DASH) score. Results. The mean follow-up period was 25 (range, 14–35) months. The mean DASH score was 35.1 at month 3 and improved to 8.9 at month 6 and 5.2 at year 1. The mean angulation was 4° in the coronal plane and 7° in the sagittal plane. All fractures united after a mean of 14 weeks. Two patients with transverse fractures had delayed union and received bone marrow injections at 12 or 13 weeks; they achieved union at week 20. One patient developed a radial nerve palsy immediately after surgery and underwent surgical exploration through the anterolateral approach. The plate was re-applied, and the nerve recovered in 48 hours with full power in all the muscle groups. Conclusion. MIPO with LCP is a safe and effective technique for fixation of diaphyseal humeral fractures, and results in faster bone union, better cosmesis, and minimal complications.

Purpose. To compare outcomes in Indian women who underwent total knee arthroplasty (TKA) using the standard Legacy Posterior Stabilised (LPS) versus the gender-specific LPS high-flexion knee prosthesis. Methods. 100 women (200 knees) aged 60 to 80 years with an arc of flexion of ≥90° underwent simultaneous sequential TKA for primary osteoarthritis of both knees. They were randomised to receive the standard NexGen LPS prosthesis (n=50) or the gender-specific NexGen LPS High-Flex prosthesis (n=50). Both knees in each patient received the same prosthesis. The resected bone from the posterior femoral condyle was 2 mm greater when the gender-specific prosthesis was used. Patients were followed up at 3, 6, 12, and 24 months. Range of motion, Knee Society score, and Hospital for Special Surgery score were evaluated pre- and post-operatively by a single assessor. Results. The mean follow-up duration was 2.1 (range, 1.6–2.5) years. Respectively for the standard and gender-specific groups, the mean range of motion was 111° and 112° preoperatively and 120° and 123° at the latest follow-up. The gender-specific group gained approximately 3° more in range of motion (p=0.007). The Knee Society score and the Hospital for Special Surgery score between groups were not significantly different pre- and post-operatively. Conclusion. The perceived advantage of a gender-specific prosthesis over a standard prosthesis did not translate into better clinical and functional outcome scores.

Acquired manus valgus or acquired radial-club hand deformity of the wrist is an uncommon entity. Pathological destruction of the distal radius, following infection, trauma, or tumorous conditions in the paediatric population, often leads to radial shortening, ulnar lengthening and angulation, distal radioulnar joint dislocation, and radial deviation of the wrist. We report a case of acquired manus valgus treated by centralisation of the ulna on the wrist. At the 2-year follow-up, the patient had a functional, stable, and cosmetically acceptable wrist, with radiographic evidence of ulnocarpal fusion. It is an easy to perform, cost-effective surgery.

Purpose. To evaluate early adolescents with nutritional rickets and their responses to treatment. Methods. 203 adolescents (aged 10 to 13 years) presenting with clinical features of lower-limb deformity, carpopedal spasm, joint swelling, a significant limp, or non-traumatic joint pain were screened for nutritional rickets. Multi-specialty examinations were performed. Family size, number of earning members, number and gender of children, preference for vegetarian food, composition of the meals, and the amount of milk consumed in a day were recorded. Radiographs of wrists, knees, ankles, and pelvis, as well as serum calcium, phosphate, and alkaline phosphatase levels were evaluated. The diagnosis of nutritional rickets was made based on a combination of clinical, radiological, and biochemical criteria, and confirmed by the responses to treatment. Children with nutritional rickets were treated by a single large intramuscular dose of vitamin D (600 000 IU) along with oral calcium and supplementary vitamin D as well as advice on diet and sunlight exposure. Results. 40 females and 11 males were diagnosed as having nutritional rickets. 65% presented with bilateral knee pain with aggravation at night, 37% presented with lower-limb deformity, 24% had joint swelling especially at the wrist and ankle, 6% had a significant limp and walked with an antalgic gait secondary to pathological fractures. No patient reported carpo-pedal spasm. All patients had rachitic changes on radiographs in some but not all bones (100% in the ulna, 45% in the radius, 37% in the upper tibia, 37% in the lower fibula and 22% in the lower tibia). Three patients had pathological fractures. 55% had hypocalcaemia, 41% had hypophosphataemia and 100% had raised serum alkaline phosphatase levels. The mean time for biochemical resolution was 12 (range, 3–24) weeks. For radiological resolution it was 5 (range, 2–6) months, with the lower end of ulna being last to resolve. Conclusions. Radiographs of the lower end of ulna and serum alkaline phosphatase levels can be used as a screening and monitoring tool for nutritional rickets in early adolescents. There may be a high prevalence of subclinical vitamin-D deficiency in our adolescent population.