Journal of Orthopedic and Spine Trauma

Association of the Cross-Sectional Area, Muscularity, and Muscle-Fat Ratio of the Paraspinal Muscles with Chronic Low Back Pain

Roop Singh, Pradeep Kumar, Jitendra Wadhwani, Svareen Kaur, Harshil Deep Singh — Mon, 24 Feb 2025 00:00:00 +0330

Background: It is now a well-established fact that paraspinal muscle integrity plays a critical role in low back pain. We aimed to determine the association of the cross-sectional area (CSA), muscle disc ratio (muscularity), and muscle fat ratio of the paraspinal muscles with chronic low back pain (CLBP) of varied pathologies, and the effect of aging and BMI.

Results: The CSAs of the muscles did not differ significantly between the two groups except for multifidus (p<0.05) and psoas (p<0.001) at L1-L2, and psoas (p<0.001) at L2-L3. There was significant difference in CSA of disc at L3-L4, L4-L5, L5-S1 (p<0.05), muscle fat ratio (p<0.01) and muscularity of multifidus and psoas (p<0.05) from L1 to L5 levels. There was no correlation of age and BMI with the CSA. Aging led to fatty infiltration in both the groups. The CSAs of muscles and discs were comparable (p>0.05) among subgroups except at few spinal levels. Muscularity among the subgroups varied at different levels. The muscle fat ratio were comparable (p>0.05).

Conclusion: Muscularity and composition rather than overall CSA of important spinal stabilizers are associated with CLBP. Age and BMI has no correlation to CSA of paraspinal muscles. Various disc and muscle parameters do not differ much among common lumbar pathologies.

Serum Magnesium and Uric Acid Levels in Patients with Rheumatoid Arthritis: A Case-Control Study

Sun, 02 Mar 2025 09:11:20 +0330

Background and aims

Rheumatoid arthritis (RA) is a chronic autoimmune disease causing joint pain, stiffness, and deformity. Genetic and environmental factors play a role in its development. Oxidative stress due to reactive oxygen species can potentially aggravate these symptoms. Studies on trace elements like magnesium (Mg) and uric acid (UA) suggest potential treatment targets. Therefore, we designed this study to compare Mg and UA levels in RA patients and healthy individuals.

Methods

This study is a cross-sectional case-control study with 43 RA patients, and 43 healthy controls. Patients with RA were diagnosed based on ACR/EULAR criteria and were categorized by disease activity score (DAS28). Blood samples were collected for laboratory tests, including uric acid, magnesium, CRP, and anti-CCP levels. Appropriate statistical approaches were used for categorical and numeric variables via SPSS software.

Results

The study found no significant difference in serum UA levels between RA patients and healthy controls. However, Mg levels were significantly lower in RA patients. Mg level was not significantly different according to DAS. A significant inverse correlation was found between magnesium and CRP levels. An ROC curve revealed that anti-CCP level had a high sensitivity for RA diagnosis, with an optimal cut-off point of 32.5 U/ml.

Conclusion

A low Mg level should be expected in patients with RA. Supplementing magnesium may be a helpful treatment approach in this group. In contrast, uric acid levels do not appear to be influenced by RA, but its antioxidant properties cannot be entirely disregarded. Moreover, anti-CCP level shows high sensitivity as a diagnostic tool for RA.

A Comparative Study between Minimally Invasive Plate Osteosynthesis versus Open Reduction and Internal Fixation for Distal Third Tibia Fractures

Sun, 02 Mar 2025 09:14:11 +0330

Background: Despite the array of surgical and non-surgical approaches available for treating distal tibia fractures, managing unstable fractures continues to pose a challenge. This study aims to compare the advantages and clinical outcomes of the Minimally Invasive Plate Osteosynthesis (MIPO) and Open Reduction and Internal Fixation (ORIF) in managing distal third tibia fractures.

Material and method: Our study focused on 60 cases selected based on age and fracture type. A comparative analysis was conducted between the two groups, considering factors such as age, gender, AO fracture type, length of hospital stay, surgical duration, complication rates, time to return to routines, and adherence to the American Orthopaedic Foot and Ankle Surgery (AOFAS) criteria. Statistical analyses were carried out using R-Studio software version 2023.06.1.

Result: The blood loss during surgery was significantly more in the ORIF group (142 ± 56.83 ml vs. 81.83 ± 37.63 ml) (P < 0.05). The incidence of complications was significantly higher in the ORIF group than MIPO group (P < 0.05). Time for back to routines was significantly shorter in the MIPO group (17.63 ± 7.86 weeks vs. 22.36 ± 8.81 weeks) (P < 0.05). There was no significant difference about duration of surgery, time of hospitalization, bone union time, and AOFAS score between the MIPO and ORIF groups.

Conclusion: The optimal method for managing distal tibia fractures remains uncertain due to discrepancies between the outcomes of MIPO and ORIF. We favor MIPO due to its potential for early bone union, quicker return to normal activities, and reduced risk of wound complications.

Evaluation of Functional Outcomes of Anterior Cruciate Ligament Reconstruction with Hamstring Autograft

Sun, 02 Mar 2025 09:15:05 +0330

INTRODUCTION: Anterior cruciate ligament is an intra-articular, extra synovial structure present in the central complex of the knee joint which along with other structures in the knee joint controls, limits motion and maintains static and dynamic equilibrium of knee joint. The knee joint is the most commonly injured of all joints and the anterior cruciate ligament is the most commonly injured ligament. The most commonly used grafts are hamstring graft and bone patellar tendon bone graft. In this study we are highlighting anatomical anterior cruciate ligament reconstruction by hamstring autograft. This study was undertaken to evaluate the results of arthroscopic anatomical anterior cruciate ligament reconstruction with hamstring graft using lysholm knee scoring scale.

METHODS: This is the study of 40 cases of arthroscopic anterior cruciate ligament reconstruction using hamstring autograft in our institute with minimum follow up of 6 months.

RESULTS: Results in this study are calculated according to lysholm knee score. 55% patients showed excellent results, 40% patients showed good results and 5% patients showed fair results. Average lysholm score is 90 in 40 patients.

CONCLUSION: Anatomical anterior cruciate ligament reconstruction using hamstring graft technique has yielded excellent to good results in almost all patients with minimal complication and provides stable knees.

Surgical Outcomes Following Instrumented Fusion in Low-Grade Spondylolisthesis: A 26-Month Retrospective Analysis

Sun, 02 Mar 2025 09:16:54 +0330

Abstract:

Introduction: The spondylolisthesis means anterior or posterior translation of the cephalad vertebra relative to the adjacent caudal vertebra. These patients with grade I-IV spondylolisthesis are treated initially by conservative measures, failing which surgical intervention is mandatory. The spectrum of available surgical options includes pars repair in spondylosis, instrumented in situ fusion, instrumented reduction and fusion, or instrumented in situ fusion which may be a posterior, posterolateral, anterior, or circumferential fusion that could be achieved by a variety of techniques. The main aim of this study is to evaluate the functional outcomes in these patients.

Method: This retrospective observational study, over 26 months, involved 30 diagnosed cases of low-grade spondylolisthesis conducted at a tertiary care center. After surgery the clinical evaluation was done with physical examination and visual analogue scale the functional outcome was evaluated by the Modified Oswestry Disability Index (ODI) at regular intervals.

Results: When the preoperative mean VAS score was compared statistically with the follow-up VAS score, a statistically significant difference was found except at 1 month as p<0.01. At 6 months, 12 months, and 24 months follow-up, the mean ODI score was 34.69 ± 5.17, 21.72 ± 5.8 and 12.51 ± 2.9 respectively. When the preoperative mean ODI score was compared statistically with the follow-up ODI score, a statistically significant difference was found except at 1 month as p<0.01.

Conclusion: This study concludes that there is an obvious improvement in ODI scores in an instrumented group of spondylolisthesis patients. Hence, the surgery is an excellent choice with good functional results in adults with grade I-IV spondylolisthesis.

Clinical and Radiographic Outcomes of Femoral Head Fractures: Insights from a Single-Center Retrospective Analysis

Reza Zandi; Nima Keyhaninejad; Shahin Talebi; Saeed Nodehi; Akbar Ehsani — Sun, 02 Mar 2025 09:19:00 +0330

Background: This study evaluates the radiologic and functional outcomes of femoral head fractures, focusing on the correlations between radiologic parameters and complications.

Methods: We conducted a retrospective analysis of 26 Pipkin fractures. Complications and outcomes were documented, with measurements taken for head-neck ratio, surface ratio in multiple planes, and head volume for further analysis.

Results: Associated injuries were observed in 65.38% of cases. Osteoarthritis developed in 61.53%, avascular necrosis of the femoral head in 50%, and heterotopic ossification in 26.92%. According to the Epstein scale, among the 26 patients, seven (26.92%) rated their outcomes as excellent, 11 (42.30%) as good, five (19.23%) as fair, and three (11.53%) as poor. Our findings indicate that head volume ratio, differences in head-neck ratio, and surface ratios in various planes correlate with late complications. Specifically, osteoarthritis was associated with the sagittal surface ratio (P=0.026) and coronal surface ratio (P=0.034) in Type II fractures, while in Type IV fractures, it correlated with the axial surface ratio (P=0.023), head volume (P=0.020), and differences in head-neck ratio (P=0.017). Heterotopic ossification was linked to head volume ratio (P=0.028) in Type II, and to coronal surface ratio (P=0.017) and differences in head-neck ratio (P<0.001) in Type IV. Avascular necrosis correlated with differences in head-neck ratio (P=0.041) in Type IV, and with head volume ratio (P=0.012) and sagittal surface ratio (P=0.012) in Type II.

Conclusion: In summary, head-neck ratio, head volume ratio, and surface ratios are predictive of late complications following femoral head fractures.

The Results of Management of Distal End Radius Fractures by Various Modalities

Sun, 02 Mar 2025 09:20:25 +0330

Introduction: Distal end radius fractures constitute 16-20% of all fractures. Extra-articular fractures are managed with closed reduction and casting, while intraarticular fractures require more invasive treatment due to instability and conservative treatment complications. Despite extensive research, the optimal treatment for distal end radius fractures remains unclear, prompting ongoing comparative studies.

Material and method:40 patients were treated and followed up for a period from 3 to 14 months. Each patient underwent detailed clinical and radiological examinations of the affected wrist, using AO Classification. Radiographs were routinely taken to evaluate extra-articular deformities and articular incongruences. Treatment decisions—plating, external fixation, or conservative management—were based on fracture type and patient physiology. Follow-ups occurred at various intervals, with assessments including hand grip strength comparison, radiographic measurements, and clinical evaluation of fracture union using Green and O’Brian scoring and Sarmiento radiological criteria

Results: Our study included 40 patients with distal end radius fractures, averaging 40.625 years old. Treatment distribution was 8 patients with reduction cast/slab, 18 with external fixators, and 14 with plating. Plating showed 57.28% excellent, 28.57% good, and 14.28% fair outcomes. External fixators had 33.33% excellent, 33.33% good, 16.67% fair, and 16.67% poor outcomes. Conservative management had 25% excellent, 37.5% good, 25% fair, and 12.5% poor outcomes.

Conclusion: We concluded that Conservative management with a reduction pop slab/cast is suitable for extra-articular fractures in elderly patients. External fixation is effective for osteoporotic or comminuted fractures. Plating is recommended for intra-articular fractures in young patients.

Keywords:distal end radius fracture,external fixator,volar plating,conservative management

Idiopathic Thoracic Spinal Cord Herniation With Neurological Involvement In Operated Lumbar Spine Surgery - A Rare Case Report

Kumar Sanjeeva Shetty, Amit Awachat, Vikas Manohar Gupte, Shrinivas Prabhu — Sun, 02 Mar 2025 09:21:36 +0330

Background: Idiopathic spinal cord herniation (ISCH) is rare ,often misdiagnosed condition without clear pathogenesis with slowly of progressive thoracic compressive myelopathy.There are less than 200 cases documented in literature.As the diagnosis is often delayed, patient may undergo unnecessary investigation which may lead to irreversible progressive neurological deterioration before confirming diagnosis. In delayed diagnosis even after surgical intervention, patients prognosis is guarded.

Keywords:Spinal cord herniation, Idiopathic spinal cord herniation, brown sequard syndrome,Dural defect, Spinal Cord kink, ISCH

Case Description: We present a case of 56 yrs old female wih gradually worsening myelopathy with mainly lower limb sensory-motor symptoms.

Conclusion: The patient with ISCH with neurologic deficit if diagnosed and treated early with surgical intervention results in good prognostic outcome.

Cervicogenic Dizziness after Humeral Fracture: A Case Report

Fateme Bokaee — Sun, 02 Mar 2025 09:22:51 +0330

Background: Cervicogenic dizziness is non-specific sensation of disequilibrium in space. Abnormal proprioceptive input from cervical spine and neck muscles may induce Cervicogenic dizziness. Trigger point activation of suboccipital muscles may be related to Cervicogenic dizziness.

Case report: Present case report describe a 38-year-old patient was refereed to physiotherapy to restore motion of right shoulder after surgery of humerus fracture. Patient reported dizziness after shoulder surgery. Patient had no medical problems induced dizziness. Physical examination revealed trigger point activation of suboccipital muscles. Myofascial release and chin tuck exercise were done and patient reported improvement for dizziness. Trigger point activation of suboccipital muscles in this patient may be related to abnormal head posture during shoulder surgery and/or impaired scapulohumeral rhythm and overactivity of cervical muscles to participate in shoulder elevation. Conclusion: It is suggested to consider possibility of existence of Cervicogenic dizziness in patients seeking physiotherapy after shoulder surgery.

Dorsal Spine Extradural Hemangioma with Neurodeficit, Mistaken Pott’s Paraplegia: A Case Report

Amit Awachat, Kumar Shetty, Vikas Gupte, Shrinivas Prabhu — Sun, 02 Mar 2025 09:23:54 +0330

Background: Vertebral hemangiomas are the most common primary vertebral tumor of spine usually vascular origin (capillary and venous malformations) and detected incidentally in most of cases. The occurrence of vertebral hemangiomas more common in females than males and is more symptomatic in the 4^th decade of life. Exact etioology is not well understood.An increase in activity can cause the vertebral hemangioma to become painful.Proliferation of hemangiomas causes erosion of bone and in some cases causes encrochment into spinal canal.

Keywords: Haemangioma , vertebral body, cord compression,potts paraplegia

Case Description: We present a case of 37 year old male with gradually progressive paraplegia and a D2 level infiltrative mass causing compression on the spinal cord.

Conclusion: Patient with vertebral hemangioma with spinal cord compression if diagnosed correctly and treated early with surgical intervention results in good prognostic outcome.