Vashishta Clinics & Hospital For Orthopaedics

25/02/2019

17/02/2019

04/02/2019

Hip Impingement
Conditions Treated

Femoroacetabular impingement (FAI), also known as hip impingement, as a mechanical or structural disorder of the hip. It can occur in people of all ages, including adolescents and young adults.In the healthy hip, the rounded top of thigh bone (femoral head) “plugs into” the hip socket (acetabular socket) in such a way that the femoral head can move smoothly within the socket. The ball and socket are lined with a thin layer of smooth cartilage that cushions and protects the bones, preventing them from rubbing or grinding against each other. The rim of the hip socket is lined with a special ridge of cartilage called the labrum that further helps to secure the femoral head in place inside the hip socket.

Hip impingement occurs when something prevents the smooth, painless, and free movement of the ball-and-socket joint.

Causes

Hip impingement may be caused by a misshapen femoral head, deformed femoral neck, or a hip socket that covers too much of the femoral head. Over time, repetitive “bumping” or impingement of the femur on the rim of the acetabulum leads to cartilage and labral damage.

People with hip impingement may have been born with a structurally abnormal ball-and-socket joint. In other cases, the hip joint may have become structurally abnormal during development. Repetitive activity involving recurrent movement of the legs beyond the normal range of motion may cause hip impingement, which has been observed in certain athletes (football, baseball, soccer, tennis, hockey, lacrosse players, dancers, and golfers). An injury may also cause symptoms of hip impingement.

Further, certain conditions, such as Perthes disease and slipped capital femoral epiphysis (SCFE), may cause hip impingement.

Types of Hip Impingement

Doctors talk about two main types of hip impingement.

Cam impingement
Pincer impingement
Cam impingement occurs because the ball-shaped end of the femur (femoral head) is not perfectly round. This interferes with the femoral head’s ability to move smoothly within the hip socket.

Pincer impingement involves excessive coverage of the femoral head by the acetabulum. With hip flexion motion, the neck of the femur bone “bumps” or impinges on the rim of the deep socket. This results in cartilage and labral damage.

Both conditions can exist at the same time, leading to cam and pincer impingement or combined impingement.

Note that hip impingement can occur with or without the presence of osteoarthritis. In fact, untreated hip impingement is thought to lead to osteoarthritis in many patients.

Symptoms

In the early stages, there may be no symptoms associated with hip impingement or symptoms may be mild or vague. Some typical symptoms include:

Stiffness in the thigh, hip, or groin
The inability to flex the hip beyond a right angle
Pain in the groin area, particularly after the hip has been flexed (such as after running or jumping or even extended periods sitting down)
Pain in the hip, groin, or lower back that can occur at rest as well as during activity
Diagnosis
An accurate diagnosis of hip impingement is crucial since, left un-treated, hip impingement can lead to cartilage damage and osteoarthritis.

The Joint Preservation, Resurfacing and Replacement department offers comprehensive diagnostic services for hip impingement. Diagnosis begins with a complete medical history and a physical examination. During the physical exam, the range of motion of the hip joint and presence of impingement will be assessed. Other tests may be required, including:

Radiography (X-rays) which produce two-dimensional images of the hip joint
Magnetic resonance imaging (MRI) which produces a three-dimensional image including soft tissue cartilage and labrum)
Computed tomography (CT) scan which takes a series of small images at different angles and then applies a computer algorithm to construct a three-dimensional image of the hip. A CT scan is often used to show doctors the detailed structure of joints.
Treatment
The Joint Preservation, Resurfacing and Replacement department will discuss appropriate treatment options with you. Some patients are able to successfully manage hip impingement with conservative therapies, including:

Reducing certain types of physical activity
Physiotherapy
>Pain management

Injections

In some cases, surgical intervention is recommended. Such surgery may be minimally invasive (arthroscopic) or open. Arthroscopic treatment is the more common and can correct most impingement deformities. Severe or complicated impingement deformities are best managed as open surgery in order to insure full correction of the deformity. In some cases, an osteotomy (literally “bone cutting”) procedure can be performed in such a way that it relieves the impingement of the hip joint. By realigning the joint properly, the abnormal contact can be reduced or eliminated. An abnormally shaped femoral head or hip socket can often be reshaped with osteoplasty or debridement. In such cases, the surgeon can “clean” or “sculpt” the ball-and-socket joint for a smoother fit.





A lateral radiograph of the hip in a 17-year-old male with hip pain is shown (1). The prominence of the femoral head-neck junction is demarcated with arrow A. This is consistent with cam impingement. This patient also has a fracture of the acetabular rim as demarcated by arrow B. At surgery (2) the femoral head demonstrates the damaged articular cartilage (arrow) and prominence of the femoral head. The surgical correction of this deformity (3) and the post-operative x-ray (4) are shown. This patient had an excellent clinical result after treatment of this impingement deformity.

For young, athletic individuals, arthroscopic or open repair of the joint may be appropriate. Arthroscopy is a specialized, minimally invasive procedure to repair the joint. Open surgery is indicated for more severe cases. Both arthroscopic and open procedures can provide excellent clinical results. After surgical repair, the patient typically undergoes a period of physical rehabilitation that can last three to four months.

In some cases, people with hip impingement may need to have a total hip replacement.

The choice of treatment depends in part on your condition, amount of arthritis in the joint, your age and activity level, and your preferences. We will help you understand the risks and benefits of various treatment options.

Facts and Figures
The rate at which hip impingement occurs in the general population is not known
Hip impingement commonly affects active adolescents and young adults
Untreated hip impingement may lead to hip osteoarthritis
Surgical management of hip impingement is successful in approximately 80% of patients at short-term follow-up.
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01/12/2018

Subluxation of the talocalcaneal joint in adults who have symptomatic flatfoot.

Abstract
BACKGROUND: When flatfoot is acquired during adulthood, the shape of the foot changes. In addition to a decreased arch, there may be valgus angulation of the hindfoot or abduction of the forefoot, or both. However, there is little objective information to provide a better understanding of the anatomical or morphological changes that occur in acquired adult flatfoot. We wondered if such an understanding of the three-dimensional anatomy might shed light on the pathway by which these changes occur. We designed this study to measure the three-dimensional position of the talocalcaneal joint in patients who have painful flatfoot.

METHODS: Computed tomography scans of the feet of eight patients who had symptomatic flatfoot were used to construct a model of the talocalcaneal articulation. The scans were performed on a custom loading frame developed to simulate weight-bearing with the foot in a neutral position while a seventy-five-newton axial compressive load was applied. The digital data from the scans were used to make three-dimensional computer models of the articular surfaces of the talus and calcaneus of each foot. These models then were used to calculate the percentage of the articular surface that was in contact and, conversely, the percentage that was subluxated. Two surfaces were modeled for each bone; the posterior facet formed one surface, and the anterior and middle facets were combined to form the second surface. The data were compared, with use of Mann-Whitney nonparametric U analysis, with those derived from scans of the feet of four patients without a deformity of the hindfoot who served as controls.

RESULTS: A mean (and standard deviation) of 68+/-9 percent of the posterior facet of the calcaneus was in contact with the talus in the patients who had flatfoot compared with 92+/-2 percent in the controls, and a mean of 51+/-23 percent of the anterior and middle facets of the calcaneus was in contact with the talus in the patients who had flatfoot compared with 95+/-6 percent in the controls. These differences were significant (p = 0.0066 for both).

CONCLUSIONS: Marked subluxation of the talocalcaneal joint occurs in some patients who have symptomatic planoabductovalgus deformity.

14/09/2018

In patients suffering with Osteoarthritis of knee joint, the cartilage lining protecting the ends of bones gradually wears off, reduction in quantity of joint fluid (Synovial fluid), and bone ends rub against each other – all of which can cause the pain.

The usual complaints are pain,stiffness, grinding sensation, swelling in and around the knee. Sometimes there is difficulty in walking for short distances and locking symptoms.

Osteoarthritis of knee can be graded / staged based amount of damage to cartilage lining. An X- ray can be useful in staging osteoarthritis of knee. It’s not only the grade but level of pain had to considered before starting a treatment.

What is Hyaluronic acid?

Hyaluronic acid is a visco-supplementation injection that lubricates and cushions your joint. It can provide pain relief in Osteoarthritic knee up to nine months to two years with just one injection. Patients with knee Osteoarthritis who have tried diet,exercise but still have pain can get benefit from this injection. The main aim of giving Hyaluronic acid injections is to decrease pain and improve functions in patients with joint pain. Hyaluronic acid injections have been shown to have the following beneficial effects on joints:

They replace some of the normal ingredients found in the synovial fluid improving the lubricating ability.
They help to stimulate the joint lining (the synovium) manufacture more normal synovial fluid.
The Hyaluronic acid coats the lining of damaged joint surfaces, covering pain nerve endings. This reduces pain and protects the joint surfaces from joint inflammation.
Hyaluronic acid also acts directly to reduce inflammation in a joint, like steroid.
How is Hyaluronic acid given?

It comes as a single injection as sterile pack from the manufactures. It is administered by intra-articluar route (directly into the knee joint). It’s a simple out- patient procedure that only takes a few minutes. You can continue with day to day normal activities after the injection. Try to avoid strenuous activities for about 48 hours.

Procedure:

- It is done in outpatient department in clean dressing room or sometimes in minor operation theater.

- Doctor prepares the knee by cleaning it with Iodine solution.

- Give local anesthesia.

- Sometimes doctor may aspirate excess fluid inside the joint.

- He then injection into the joint directly

- You can walk out immediately after the procedure.

Frequently asked questions?

1. What you can expect following a hyaluronic acid injection?

Hyaluronic acid can provide pain relief upto nine months to two years.

2. Will the injection be painful?

Since the injection is given through small needle and directly into the joint there wouldn’t be severe pain. Sometimes doctor can give local anaesthesia to numb the area before giving injection.

You may feel mild pain and swelling of knee after injection which is normal. Place an ice pack on your knee for 10 min at regular intervals.

3. What happens after the injection?

During the first couple of days-

Return to normal day to day activities.

Avoid strenuous activities such as jogging lifting weights for first 48 hours.

During following months –

The intensity of osteoarthritic pain comes down and pain relief varies from patient to patient. The benefits of injection can last for 9 months to 2 years depending on stage of osteoarthritis, vary with patients.

These injections can be repeated safely.

4. What are the side effects of injection?

Before taking the injection you should inform your doctor about any allergic reactions to Hyaluronan products or avian proteins (Chicken). Some side effects are mild and temporary like

Allergic reactions, pain, swelling, stiffness.

15/12/2017

Bennett fracture is a fracture of the base of the first metacarpal bonewhich extends into the carpometacarpal (CMC) joint.[1] This intra-articularfracture is the most common type of fracture of the thumb, and is nearly always accompanied by some degree of subluxation or frank dislocationof the carpometacarpal joint.
Contents

Symptoms and signs
Symptoms of Bennett fracture are instability of the CMC joint of the thumb, accompanied by pain and weakness of the pinch grasp. Characteristic signs include pain, swelling, and ecchymosis around the base of the thumb and thenar eminence, and especially over the CMC joint of the thumb. Physical examination demonstrates instability of the CMC joint of the thumb. The patient will often manifest a weakened ability to grasp objects or perform such tasks as tying shoes and tearing a piece of paper. Other complaints include intense pain experienced upon catching the thumb on an object, such as when reaching into a pants pocket.
Complications
Many important activities of daily life are dependent on the ability to grasp, pinch, and oppose the thumb. In fact, thumb function constitutes about 50% of overall hand function. These abilities are in turn dependent on an intact and functional thumb CMC joint. The CMC joint of the thumb allows a wide range of motion while maintaining stability for grasp and pinch.
With this in mind, failure to properly recognize and treat the Bennett fracture will not only result in an unstable, painful, arthritic CMC joint with diminished range of motion: it will also result in a hand with greatly diminished overall function.
In the case of the Bennett fracture, the proximal metacarpal fragment remains attached to the anterior oblique ligament, which in turn is attached to the tubercle of the trapezium bone of the CMC joint. This ligamentous attachment ensures that the proximal fragment remains in its correct anatomical position.
The distal fragment of the first metacarpal bone possesses the majority of the articular surface of the first CMC joint. Unlike the proximal fracture fragment, strong ligaments and muscle tendons of the hand tend to pull this fragment out of its correct anatomical position.
Specifically:
• tension from the abductor pollicis longus muscle (APL) subluxates the fragment in a dorsal, radial, and proximal direction
• tension from the APL rotates the fragment into supination
• tension from the adductor pollicis muscle (ADP) displaces the metacarpal head into the palm
Tension from the APL and ADP muscles frequently leads to displacement of the fracture fragments, even in cases where the fracture fragments are initially in their proper anatomic position. Because of the aforementioned biomechanical features, Bennett fractures nearly always require some form of intervention to ensure healing in the correct anatomical position and restoration of proper function of the thumb CMC joint.
Mechanism of injury

Bennett's fracture
The Bennett fracture is an oblique intraarticular metacarpal fracture dislocation, caused by an axial force directed against the partially flexed metacarpal. This type of compression along the metacarpal bone is often sustained when a person punches a hard object, such as the skull or tibia of an opponent, or a wall. It can also occur as a result of a fall onto the thumb. This is a common injury sustained from bike falls, as the thumb is generally extended while around the handle bars. It is also a common injury in car crashes, especially into fixed objects, from the driver holding the steering wheel during impact. The hand moves forward, while the steering wheel rim hyperextends the thumb.
Some authors have recently made an assertion against popular belief that the APL tendon is not a deforming force on the Bennett fracture.[2]
Treatment

Bennett's fracture repair
Though these fractures commonly appear quite subtle or even inconsequential on radiographs, they can result in severe long-term dysfunction of the hand if left untreated. In his original description of this type of fracture in 1882, Bennett stressed the need for early diagnosis and treatment in order to prevent loss of function of the thumb CMC joint, which is critical to the overall function of the hand.[3]
• In the most minor cases of Bennett fracture, there may be only small avulsion fractures, relatively little joint instability, and minimal subluxation of the CMC joint (less than 1 mm). In such cases, closed reduction followed by immobilization in a thumb spica cast and serial radiography may be all that is required for effective treatment.[4]
• For Bennett fractures where there is between 1 mm and 3 mm of displacement at the trapeziometacarpal joint, closed reduction and percutaneous pin fixation (CRPP) with Kirschner wires is often sufficient to ensure a satisfactory functional outcome. The wires are not employed to connect the two fracture fragments together, but rather to secure the first or second metacarpal to the trapezium.
• For Bennett fractures where there is more than 3 mm of displacement at the trapeziometacarpal joint, open reduction and internal fixation (ORIF) is typically recommended.
Regardless of which approach is employed (nonsurgical, CRPP, or ORIF), immobilization in a cast or thumb spica splint is required for four to six weeks.
Prognosis
If intraarticular trapeziometacarpal fractures (such as the Bennett or Rolando fractures) are allowed to heal in a displaced position, significant post-traumatic osteoarthritis of the base of the thumb is virtually assured.[5] Some form of surgical treatment (typically either a CRPP or an ORIF) is nearly always recommended to ensure a satisfactory outcome for these fractures, if there is significant displacement.
The long-term outcome after surgical treatment appears to be similar, whether the CRPP or the ORIF approach is used. Specifically, the overall strength of the affected hand is typically diminished, and post-traumatic osteoarthritis tends to develop in almost all cases. The degree of weakness and the severity of osteoarthritis does however appear to correlate with the quality of reduction of the fracture. Therefore, the goal of treatment of Bennett fracture should be to achieve the most precise reduction possible, whether by the CRPP or the ORIF approach.[6]
Nomenclature
The Bennett fracture is named after Edward Hallaran Bennett, Professor of Surgery (1837–1907) at Trinity College of the University of Dublin, who described it in 1882. Bennett said his fracture "passed obliquely across the base of the bone, detaching the greater part of the articular surface, and "the separated fragment was very large and the deformity that resulted there-from seemed more a dorsal subluxation of the first metacarpal".[3]