Journal of Orthopedic and Spine Trauma
Volume:9 Issue: 3, Sep 2023

The diabetic foot is a chronic complication of diabetes. There is a strong relationship between glucose levels, the severity of diabetic foot ulcers (DFUs), and the need for amputation. This study aimed to evaluate the blood sugar (BS) trends before and after surgery in patients with DFU who had been amputated.

The adult patients who had undergone DFU-related amputation surgery between 2017 and 2020 in Imam Khomeini Hospital Complex, Tehran, Iran, were evaluated. The cases whose BS levels were charted at least three days before and after amputation were recruited. The main data, including hypoglycemia (defined as a blood glucose level < 70 mg/dl) and mean BS and fasting BS (FBS) levels, were recorded. The data were then analyzed and compared before and after amputation.

Of 267 patients reviewed for inclusion criteria, 55 patients were included in the study. Twenty-eight patients (50.9%) were men, and the mean age was 60 years. The mean FBS before and after amputation was 229.5 and 181.3 mg/dl, respectively, and the mean BS before and after amputation was 227.3 and 197.8 mg/dl, respectively. The differences were significant (P < 0.001). Twelve patients (21.8%) before and 21 patients (36.4%) after amputation suffered from hypoglycemia (P = 0.057).

DFU-related amputation is associated with a significant decrease in blood glucose levels and inflammatory indexes. However, it can increase the risk of hypoglycemia during the first three days after the surgery.

In the present study, the effectiveness of a controlled-release drug delivery system of chitosan hydrogel loaded with ketorolac and buprenorphine on oxidative stress indices and albumin changes in the experimental bone defect model was considered.

After creating an experimental defect in the right tibia of each rat, 5 groups, including (A) the control group that did not receive any pharmacological intervention, (B) the chitosan hydrogel receiving group, (C) the group receiving chitosan hydrogel loaded with buprenorphine, (D) the group receiving chitosan hydrogel loaded with ketorolac, and (E) the group receiving chitosan hydrogel loaded with ketorolac and buprenorphine, were considered. Serum concentrations of antioxidant factors and albumin levels were then measured on days 0, 3, 7, and 21 after surgery.

In the control group, the maximum amount of oxidative stress and the maximum activity of antioxidant enzymes on the third and seventh days were compared between the 4 treatment groups. Moreover, the maximum amount of albumin on the third day was recorded and compared between the 4 other treatment groups. In 4 treatment groups, a significant decrease was observed in the mean of parameters related to oxidative stress compared to the control group, which was more noticeable in the group receiving ketorolac.

In the present study, the highest rate of control of oxidative stress conditions was observed in the group treated with the ketorolac-loaded chitosan hydrogel system, possibly due to its antioxidant properties and better control of inflammatory conditions caused by the use of chitosan and ketorolac in this treatment group.

Pediatric femoral shaft fractures are one of the common fractures that we encounter in the orthopedics outpatient department. These fractures have various treatment options ranging from traction and early hip spica casting to elastic titanium intramedullary nails [titanium elastic nailing system (TENS)] and reamed intramedullary nails. In this study, we are evaluating the functional outcome and results following the use of flexible intramedullary nails and conservative management for femoral shaft fractures in children.

This was a prospective observational study which was carried out in a tertiary care hospital from October 2015 to May 2017 for two groups of children who sustained traumatic femoral shaft fractures. A total of 40 patients were taken into consideration with 20 patients each in two groups.

The male-to-female ratio was 2.6:1 in our study population. The overall post-operative complication rate was more in the TENS group. Besides, we found that the TENS group of patients had a less limb length discrepancy (LLD) (P = 0.004) and a lower degree of angular deformity (P = 0.36).

TENS demonstrated advantages including sufficient axial stability, early mobilization, and more rapid return to function than spica cast treatment; however, it had the drawback of possible infection and pin site irritation. Overall, TENS offers a minimally invasive method for treatment of the femoral shaft fractures in children which stands superior to traditio nal spica casting.

Forearm shaft fractures are common in developing countries. Anatomical reduction of these fractures using plates and screws is considered an accepted treatment mode. Like other shaft fractures, this can be treated with intramedullary nails like square nails, Rush nails, and interlocking nails. This study evaluates radiological and functional treatment results using square nailing.

A prospective study was conducted on 100 adult patients with diaphyseal forearm fractures over 3 years. Out of 100 patients, 68 were men, and 32 were women. Patients were followed up at 2 weeks, 6 weeks, 8 weeks, and then every 3 months till 1 to 1.5 years. We have used criteria described by Anderson et al. and the shortened version of the Disabilities of the Arm, Shoulder, and Hand (QuickDASH) score for functional evaluation of the patients.

Out of 100 patients, the union was achieved in 88 patients, while the rest 12 patients required re-surgery. 4 patients had delayed union, 4 patients developed an infection at the ulnar entry site, and 3 patients developed bursitis of olecranon bursa.

Intramedullary nailing of both bone forearm shaft fractures using square nails can give satisfactory results in most cases, comparable with treatment by plates and screws, and provides an alternative, cost-effective treatment of both bone forearm shafts fractures with good cosmesis owing to small incisions.

Since long, thoracolumbar burst fractures have been treated either by prolonged bed rest or by surgical fixation. In this study, outcomes of early mobilization with non-operative treatment are evaluated to avoid unnecessary surgery and complications of prolonged bed rest.

This prospective observational study included 40 patients with thoracolumbar burst fractures with no neurological deficit. Patients were mobilized with Taylor’s brace as soon as acute pain subsided and reviewed for at least two years with standing radiographs. They were evaluated for anterior vertebral height loss (VHL), kyphotic angle (KA), pain by Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and neurological deterioration at presentation, one month, six months, and two years.

The mean progression of kyphosis over two years was 7.8 degrees. The mean VHL also progressed from a mean of 51.9% at presentation to 60.4% at the two-year follow-up, a mean progression of 8.5%. At two years of follow-up, the mean ODI and the mean VAS score were 10.1% and 0.7, respectively. No patient developed a neurological deficit.

Even though there is some deterioration in radiological parameters, there is constant improvement in functional parameters. For these fractures, non-operative management using a brace and early mobilization promises comparable results without the cost and risk of surgery.

The presence of sudden-onset fibromyalgia (FM) is poorly understood, characterized, and appreciated in both previous literature and the clinical setting. In this case series, we present 10 cases of sudden-onset FM seen in a community-based pain clinic, to characterize the presentation of this condition, stemming from both external trauma and idiopathic etiology.

This retrospective case series identified 10 patients diagnosed with FM attending the pain clinic. These patients were referred to chronic pain management clinic in Thunder Bay, Ontario, Canada, from January 2019 until December 2021 and met the diagnostic criteria for FM. Information was collected on sex, gender, age, details of signs and symptoms, and FM severity score as well as clinical findings and outcomes.

The case series identified 10 community residents (9 women and 1 man, F/M: 9/1, age range: 34-64 years, mean age: 51.7 years), with symptoms attributed to FM. Majority of patients suffered from total body pain and mental disorders such as depression. 60% of patients were on opioids at the time of referral. Combination of pharmacological and non-pharmacological management improved their pain symptoms within 3-6 months on follow-up.

Overall, effectively identifying sudden-onset FM can help clinicians improve patient-oriented outcomes and avoid the use of unnecessary narcotics in addition to better treating their patients.

The interphalangeal (IP) joint dislocation of hallux is a rare occurrence probably due to the presence of strong ligamentous attachments around it. Closed reduction of this kind of dislocation proves to be unsatisfactory. Herein, we are presenting a case of an open dorsomedial type of IP joint dislocation following a road traffic accident

Case Report: 

A 36-year-old woman with injury to her right great toe following a road traffic accident presented in the casualty of Chettinad Hospital, Kelambakkam, India. On examination, there was a 3 × 2 cm laceration present over the medial-plantar aspect. The bone was exposed. Hallux varus deformity was noted due to the dislocation of the IP joint. The reduction of IP joint dislocation was quite unstable and was fixed with two 1mm Kirschner wires (K-wires) under fluoroscopic guidance. The patient was sequentially followed up on the 4th and 6th weeks post-op. Joint integrity and stability were assessed which were found to be satisfactory after the removal of K-wire on the 6th week post-op.

Open IP dislocations of the hallux Miki type 2 are unstable types of injury to deal with. Closed reduction in these injuries is difficult owing to the impinging sesamoid bone along with other soft tissues. These types of injuries should be reduced and fixed with K-wires to have better stability followed by long-term immobilization of around 3 to 4 weeks.

Familial synovial hypertrophy is a rare condition presenting as the flexion contracture of the small joints of the hands and feet, in addition to the large joint effusion and range of motion (ROM) restriction.

Case Report:

 Herein, we introduce a 14-year-old boy with a long history of deformities in the hand and foot joints. Painless swelling and limited motion of big joints were present since birth. There were no similar diseases in paternal or maternal relatives, while his 9-year-old brother also had a lifelong history of same deformities.

Involvement of the hands and feet can severely restrict young patients’ function in daily tasks, raising the importance of early diagnosis and treatment in familial synovial hypertrophy.

The talus bone is the second-largest bone in the tarsal region. Talar fractures are rare injuries that occur due to high- energy traumas. Open reduction and internal fixation (ORIF) is the treatment of choice in the talar body fracture-dislocation. Avascular necrosis (AVN), osteoarthritis (OA), malunion, non-union, skin infections, and ankylosis of the subtalar joint are complications that can happen following the talar body fracture.

Case Report:

 We reported a rare open fracture-dislocation of the talar body concomitant with the anterior talofibular ligament (ATFL) rupture in a 24-year-old motorcyclist man. ORIF with two 4.5 mm cancellous screws and ATFL repair were performed. After 6 months of follow-up, the radiographic bone union was achieved, and the patient had no complaints of pain, disability, and discomfort.

According to the blood supply of the talus bone, appropriate management and follow-up should be considered to prevent severe consequences. Due to the lack of literature on this lesion, in this report, we tried to provide more comprehensive information regarding the diagnosis, treatment, and follow-up of this group of patients. To the best of our knowledge, our case will probably be the second case of the talar body fracture concomitant with rupture of the ATFL.