Indian J Orthop
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Filling bone defect after debridement of infected nonunion is an orthopedic challenge. Since the volume of autologous bone graft available is limited, allograft, demineralized bone matrix, and calcium phosphate ceramic-based bone graft substitutes have come up as potential autograft expanders. This study was conducted to analyze the use of beta tri-calcium phosphate (B-TCP)-based composite ceramic as autologous bone-graft expander in the management of postinfective segmental gap nonunion of long bones managed with two-stage Masquelet's technique. ⋯ B-TCP is an efficacious and safe autologous bone graft expander in Masquelet's two-stage management of post infective segmental gap nonunion of long bones. Patients should be counseled regarding increased risk of nonunion and need for repeat grafting with its use, especially if they are smokers or site of involvement is tibia.
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Nursemaid's elbow (NE) represents the most common pathology met in the pediatric orthopedics ambulatory. There are two techniques of reducing the NE: the supination-flexion technique and the hyperpronation or forced pronation technique. ⋯ This study concludes that hyperpronation technique should be used as a first maneuver reduction in treating NE, a simple one-movement technique.
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The most appropriate fusion levels remains challenging, especially in Lenke type 5 curves. In Lenke 5 adolescent idiopathic scoliosis (AIS) generally fusion includes the lower end vertebra (LEV). This study determines whether it is appropriate to fuse mild to moderate Lenke 5 curves to LEV-1, if possible. ⋯ Fusion to LEV-1was associated with the higher amount of LIV disc angle and LIV translation, which did not cause coronal and sagittal imbalance and decreased the quality of life scores. Hence, if intraoperatively a level disc below LIV can be achieved, fusion to LEV-1 may be an option in mild to moderate Lenke 5 curves, to save one more mobile segment.
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The treatment of comminuted tibia plafond fractures remains clinically challenging due to the complexity of the articular fracture pattern despite using the anatomically precontoured locked plates. This study describes the morphologic characteristics of the anterolateral fragment and to evaluate the fixability of the anterolateral fragment with the anatomically precontoured locked plate in the pilon fracture. ⋯ Anatomical distal tibial locked plates did not take purchase on the anterolateral fragment in pilon fracture in the best anatomical fit. Preoperative CT measurement can be used for determining a fixation strategy for the anterolateral fragment. In addition, a newly designed anterolateral distal tibia plate can be another solution when the usual anatomically precontoured distal tibia locked plate fails to cover the anterolateral fragment.
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In the current clinical scenario, restenosis following the primary surgical procedure for lumbar canal stenosis is being frequently noticed. A number of studies have evaluated the reoperation rates following different surgical procedures for lumbar canal stenosis. However, a dilemma still exists about the surgical procedures, associated comorbidities and reoperation rates. ⋯ Smoking is an independent risk factor for revision surgery. Diabetes reduces the time interval between the initial surgery and the revision surgery. This review highlights the causes of reoperations in various lumbar stenosis surgeries, associated comorbidities and expected outcome.