Clinico-radiological outcome of distal radius fractures managed with closed reduction during COVID-19 pandemic

<p><strong>Background:</strong> distal radius fractures are the most common fractures of the upper extremity and account for more than 1/6 of all fractures treated in emergency department the elderly population account for 18% of all distal end radius fractures and have a significant impact on health of young adults. An optimal outcome of closed treatment of a Colle’s fracture may depend on accurate reduction and adequate immobilization.</p><p class="abstract"><strong>Methods:</strong> A total 45 patients with displaced Colle’s-type fractures were subjected to treatment with closed reduction with manual manipulation. The fractures were assessed radiographically by measurement of the radial angle, dorsal tilt, and radial shortening before reduction, immediately after reduction, and at one and five weeks after reduction. Data was recorded and assessed.</p><p class="abstract"><strong>Results: </strong>Anatomical outcome as per Sarmiento criteria. 66.67% patients had excellent result with no residual Deformity, 17.77% patients had good result with mild residual deformity, 8.88% of them show fair results with moderate residual deformity and 6.66 % had poor outcome.</p><p class="abstract"><strong>Conclusions: </strong>Coronavirus disease 2019 (COVID-19) pandemic was burden on all including patients and medical fraternity, and considering looming threat of third wave and delta variant of virus, our study material can be used to make guidelines for optimal utilisation of orthopaedic fraternity, who have to work in COVID wards as well as trauma wards, our study shows that proper technique of fracture reduction with patient counselling and early physiotherapy can yield good results in fracture which can be managed conservatively.</p><p> </p>

Percutaneous Chevron and Akin (PECA) Osteotomies for Severe Hallux Valgus Deformity With Mean 3-Year Follow-up

Background: Patients with severe hallux valgus deformity present technical and operative challenges with high rates of recurrence and residual deformity. The clinical and radiologic outcomes of percutaneous surgery for severe hallux valgus are not known. Methods: A retrospective review of consecutive patients with a hallux valgus angle (HVA) >40 degrees or intermetatarsal angle (IMA) >20 degrees who underwent third-generation percutaneous chevron and Akin osteotomy (PECA) for hallux valgus deformity correction. Results: Between December 2012 and August 2019, 59 feet in 50 patients underwent PECA. Preoperative and follow-up radiographic data were available for 53 feet (89.8%). Postoperative clinical patient-reported outcome measures and satisfaction results were available for 51 feet (86.4%). The mean clinical and radiographic follow-up was 3.1 years and the mean postoperative Manchester-Oxford Foot Questionnaire Index score was 15.1. There was a statistically significant improvement ( P < .001) in both IMA and HVA following surgery (IMA 17.5-5.1 degrees; HVA 44.1-11.5 degrees). All patients reported they were satisfied with their outcome, with 76.8% reporting they were highly satisfied. The hallux valgus recurrence rate was 7.5%. Conclusion: Percutaneous surgery for severe hallux valgus deformity can achieve a large deformity correction, patient satisfaction, and quality of life, with reasonable rates of residual deformity and low rates of recurrence. Level of Evidence: IV

Bilateral femoral head reshaping and mosaicplasty in Legg–Calvé–Perthes disease residual deformity

Residual hip deformity secondary to Perthes disease may lead to early symptomatic joint degeneration. The altered anatomy results in biomechanical and biological problems that can be surgically addressed in adolescents or young adults with hip preservation procedures. This case report aims to demonstrate a customized surgical treatment performed on a 15-year-old male who developed painful hips with significant intra- and extra-articular impingement, secondary to bilateral Leg–Calvé–Perthes disease residual deformity. Intra-articular procedures were executed through a safe surgical dislocation of the hip, with a mosaicplasty using osteochondral autografts from the exceeding peripheral ipsilateral femoral head, a femoral head–neck osteochondroplasty and a labrum repair. A relative lengthening of the femoral neck was also carried out with a trochanteric advancement to solve the extra-articular issues. On follow-up, he referred to a substantial improvement in pain and function, being his radiographic studies satisfactory. At 4 and 5 years from surgery, the patient was able to exercise regularly with minimal complaints, with a Harris Hip Score of 85.85% and a Hip Outcome Score of 94.1% for activities of daily life and 86.1% for sports. In patients with hip deformity after healed Perthes disease, treatment strategies that address both the morphological disturbance of coxa magna, plana and breva, as well as the biological concerns arising from osteochondral injuries or labral tears, and mechanical dysfunctions lead to improvements in symptomatology, function and medium-term prognosis. Further procedures to address residual adaptative acetabular dysplasia would favor outcomes of conservative hip surgery in the sequelae of LCPD.

649 COVID BOAST In Practice: Our Experience Implementing BOA Recommendations During the UK Coronavirus Pandemic Peak

Background In anticipation of the UK coronavirus pandemic peak, BOA published new pandemic-specific guidance (“COVID BOAST”) in April 2020. We describe our experience implementing this restructured T&O service in a busy DGH setting during the pandemic peak. Method A rapid retrospective audit was conducted of all patients presenting to our T&O service in April 2020, with particular emphasis compliance with COVID BOAST. Results Our service conducted 511 outpatient reviews, and 95 operative procedures. 94% of outpatients were treated non-operatively. We provided telephone appointments to 12.8% of follow-up patients, and 39% of new patients. 82% of patients were treated with removable casts/splints/boots. 23% of patients were discharged direct from VFC or after one face-to-face fracture clinic review. Residual deformity was consciously accepted in 13% of patients. Theatre throughput fell significantly due to pandemic precautions however, femoral neck fracture volumes remained constant. Conclusions We demonstrate broad compliance with COVID BOAST guidance. The majority of patients were treated non-operatively, including conscious acceptance of residual deformity. Our pre-existing VFC allowed us to provide a significant number of telephone consultations, although despite the practice shift towards removable splintage, face-to-face consultations were required for clinical and/or radiological assessment. The impact of increased conservative management on patients’ long-term outcomes needs further evaluation.

MANAGEMENT OF RELAPSE CLUBFOOT BY PERCUTANEOUS TENDON RELEASE WITH APPLICATION OF CORRECTIVE CAST AND ANALYSIS OF RESULT THROUGH PIRANI SCORE, PODOGRAPH FOOT BIMALLEOLAR ANGLE, RADIOLOGICAL FOOT ANGLES AND FUNCTIONAL FOOT SCORE.

Aim:-The aim of our study to evaluate the effectiveness of percutaneous tendon release and application of corrective cast in children who had undergone serial corrective cast but had some Residual deformity Material and method :-We have included total 18 patient of Relapse clubfoot (with 22 clubfeet) in our study.The age group of patient between 6 month to 36 month.All these patient treated by percutaneous tendon release procedure and application of corrective cast.then result analysis by pirani score, podograph foot bimalleolarangle,and radiological foot angles at follow up of 1,6,12 month. Result:-pirani score result excellent in 10 feet (score<0.5),good in 10 feet(score<1.5),and fair in 2feet (score<2). Podograph foot bimalleolar angle(FBA) in 19 feet (87%)[angle >75°],FBA in 2 feet (9%)[angle70-74°],FBA in 1 feet (4% ) [angle 65-69°]. Radiological foot angleApTalocalcaneal angle mean change(7.42°) ,lateral Talocalcaneal angle mean change(7.09°) ,AP Talorst metatarsal angle mean(7.0°) , Tibiocalcaneal angle meanchange(18.66°) , Talocalcaneal index meanchange (14.65°) Laaveg ponseti and Cummings functional score excellent (85-100) in 4feet(18%),Good (70-84) in 12feet(54%), fair(60-69)in 3feet(14%), Poor (below 59)in 3feet(14%). Conclusion:-Percutaneous tendon release with application of corrective cast is safe and easy method for correction of Relapse clubfoot with less risk of wound complications,neurovascular injury and post operative scar mark.

Parotid gland tuberculosis-presentation of 4 case variants

Pulmonary tuberculosis is a necrotizing granulomatous disease with diverse presentation. Nevertheless, extra pulmonary involvement although rare even in endemic regions, is associated with diagnostic dilemma for confirmation and treatment modalities. Contextually, parotid gland tuberculosis is a rare surgical presentation because of nonspecific signs, symptoms and allegedly low incidence; it is often misdiagnosed as parotid neoplasm, and therefore remains a diagnostic paradox. However, clinical suspicion alongside pathological evidence and imaging helps in diagnosing indecisive questionable cases. We present 4 cases of parotid tuberculosis each with different clinical presentation along with clinical suspicion and pathological diagnosis. Parotid tuberculosis is a rare clinical entity and completely curable by category-I anti-tubercular therapy. It has no residual deformity if diagnosed timely followed by conservative treatment management.

Septal deviation correction methods and surgical considerations in turbinoplasty

Nasal septoplasty is often required to correct a cosmetic deformity, which is a common reason for patients to present to a plastic surgeon. If nasal septoplasty is insufficient, a residual deformity or nasal obstruction may remain after surgery. Even if the nasal septum is corrected to an appropriate position, nasal congestion could be exacerbated if the turbinate on the other side is not also corrected. Therefore, appropriate treatment is required based on the condition of the turbinates. Herein, we survey recent trends in treatment and review previous research papers on turbinoplasty procedures that can be performed alongside nasal septoplasty.