There is a Minimal Difference in Ankle Functional Outcomes After Peroneus Longus Harvest: Systematic Review and Meta-analysis

Importance

Recently, peroneus longus (PL) autograft as a graft choice for ligament surgeries have attracted interest due to studies showing good clinical outcomes and minimal donor site morbidity. There remain concerns related to these grafts, especially the potential impact on ankle functions.

Aims/Objective

The purpose of this review and meta-analysis is to summarize the available evidence for ankle functional outcomes after PL harvest. This will provide objective clinical evidence for surgical decision making.

Evidence Review

Cochrane, Embase, Medline, and Google Scholar were all searched for articles published between January 2001 and May 2021. For the aim of a systematic review, certain inclusion and exclusion criteria were adopted in accordance with PRISMA recommendations. The primary outcome measure was the assessment of ankle functional outcomes using validated instruments (such as AOFAS score, FADI score etc.).

Findings

A total of twelve studies representing pooled patient populations of 537 patients were included in this review. The average follow-up duration was 17 months (range; 6-32 months) across all studies. All twelve studies assessed AOFAS score and six studies also additionally assessed FADI score. The pooled mean outcomes measured showed a slight decrease in post-operative as compared to pre-operative AOFAS and FADI score (mean difference of AOFAS 1.92, 95% CI 1.021-3.123, p value < 0.05 and mean difference for FADI 1.50, 95% CI 0.561-2.445, p value < 0.05). Though statistically significant the magnitude of variance implies minimal clinical impact.

Conclusion and Relevance

This review and meta-analysis found that PL autograft harvest leads to statistically significant but minimal impact on ankle functional outcomes. This, in conjunction with various studies on ankle parameters after PL harvest, shows that PL harvest leads to minimal impact on ankle outcomes and function.

Level of Evidence

Systematic review Level III.

Bilateral Anterior Cruciate Ligament Reconstruction Using Gracilis and Semitendinosus Graft by Single-Staged Approach

A bilateral anterior cruciate ligament (ACL) tear is one of the rare injuries that is seen in orthopaedics practice. Although few single-staged bilateral ACL ruptures have also been documented, most bilateral ACL ruptures happen on two different occasions. Although there isn't a clear consensus, there have been accounts of both single-staged and two-staged reconstruction of bilateral ACL ruptures in the literature. This case report provides surgeons with options to consider while treating this unusual injury. A 35-year-old woman with bilateral anterior cruciate ligament injuries presented with an MRI of her left knee suggestive of a complete ACL tear with a Medial meniscus tear in the left knee, and an MRI of her right knee showed a complete ACL tear. The patient underwent arthroscopic ACL reconstruction in a single stage for both knees. Six months after her surgery, she had met all the rehabilitation goals and was cleared to resume her daily activities. The patient preoperatively had a visual analogue scale (VAS) score of 8, and postoperative assessment, her VAS score reduced to 2. ACL reconstruction in one stage and two stages were the surgical treatment modalities described in the literature. Concurrent rehabilitation of both ACL repairs is more economical, reduces hospital stay, and helps in early recovery, but it may result in severe quadriceps deconditioning. Double-staged surgeries are less demanding, with a shorter duration of surgery that can be performed by a less experienced surgeon. As single-staged bilateral ACL reconstruction is a less expensive option that reduces hospital stays and aids in early recovery for this rare patient population, it may be a great therapy option compared to two-staged bilateral ACL reconstruction.

Ilizarov Ring Fixator in the Lower Limb for 2000 Days: A Case Report

Ring external fixators developed by Gavriil Abramovich Ilizarov from Russia are used to treat the difficult cases of infected non-union, shortening of limbs by bone lengthening, and deformity correction in joints and bones in isolation or in combination. Fixation of the involved bone with the ring is commonly achieved using four rings, each having two Ilizarov wires that are passed along the superior surface of the ring, then across the bone, and exiting out on the opposite side touching the surface of the ring. The case report herein reports a patient who kept the ring fixator on his thigh without any problem for a long period of five and a half years. The case is being reported due to the abnormally long period of ring fixator application without any complications and the excellent result achieved in terms of union and infection control.

Use of Endobutton for Small Avulsion Fracture of Coronoid in the Terrible Triad of the Elbow: A Case Report

The terrible triad (TT) of the elbow consists of coronoid process (CP) fracture, fracture of the radial head (RH), and posterior dislocation. Although the coronoid is an important anterior stabilizer, it is still unclear how to treat comminuted coronoid fractures. Poor fixation of the CP tends to result in posterolateral instability at the elbow joint and often in chronic instability. The ligamentous injuries also cause instability in elbow dislocations and should be suspected. There are various techniques available for coronoid fracture fixation. In this case report, we want to highlight our experience managing a 47-year-old male with posterior dislocation of the elbow after computed tomography (CT) confirmed that the patient had an RH fracture with an avulsion fracture of the coronoid. This TT of the elbow was managed with the help of an endobutton and a Herbert screw for coronoid avulsion fracture and RH fracture, respectively, through a lateral (Kocher) approach in our tertiary care hospital with satisfactory results. The use of endobutton is recommended in type 1 and type 2 coronoid fractures with no or minimal capsular attachment for good suspensory effect, and it emphasizes the possibility of associated coronoid fracture in case of posterior elbow dislocation. This case report emphasizes the fixation of even small fragments of the coronoid fracture for better stability and early mobilization. Postoperative rehabilitation involved using a hinged brace and early mobilization to avoid a stiff elbow and periodic X-rays to check the heterotopic ossification risk.

Surgical Repair of Achilles Tendon Rupture by Turn-O-Plasty: A Case Report

Achilles tendon rupture has been a difficult problem for surgeons, especially in older patients, since tendon strength and flexibility are significantly diminished compared to young people. The Achilles tendon endures the highest tensile stresses in the body while running, leaping, and skipping, with tensile loads up to 10 times body weight. There are many treatment options for Achilles tendon repair, including open surgery, percutaneous repair, and ultrasound therapy. Open repair has the danger of scar dehiscence owing to poor skin conditions. In contrast, small invasive operations have the risk of sural nerve damage and a higher possibility of re-rupture. The gold standard method or approach is still under question. Plantar flexion in the ankle is primarily a function of the Achilles tendon; hence, post-operative plantar flexion is a significant determinant of the desired result. We present the case of a 57-year-old male farmer suffering from a left Achilles tendon rupture due to trivial trauma. This rupture consisted of a significant defect, present in the watershed area with signs of tendinosis at the insertion of the tendon. The patient was managed surgically by turn-o-plasty and the degenerated insertion site was augmented with the help of a suture disc. This case report focuses on surgical management by turn-o-plasty for significant defects in the Achilles tendon by using a suture disc to augment the defect.

Fractures of Tibia Diaphysis Managed with Internal Fixation by Elastic Nails: An Alternative Approach

Background: Intramedullary nailing techniques specially using elastic nails like Enders nail are a good treatment option, owing to their cost effectiveness, less use of fluroscopy and ease of procedure with short learning curve. This study is aimed to bring evidence to the hypothesis that Ender nails can be used successfully in tibia shaft fractures under certain indications. Due to the economic nature and easy procedure, we aimed specifically to demonstrate that elastic IM nailing, esp. Ender nails can be a good alternative to interlock nailing for select cases of diaphyseal fractures. The study aims at evaluating outcome of Enders nail in diaphyseal tibia fractures. Material and Methods: This study was carried on in the Department of Orthopaedics, tertiary care hospital during the period of April 2019 to March 2020. It is a prospective type of study. Patients were evaluated based on functionality and radiology, post-surgery. Results: A total of 30 patients of tibial shaft fractures were selected and managed with closed reduction and internal fixation with Enders nail. Male to female ratio was 4:1. 24 (80%) patients sustained injury from motor vehicular accidents. 40% patients with open fracture and 60% closed fracture patients were involved. 60% if the patients showed clinic-radiological union in 12-14 weeks, while 50% of the patients achieved a post operative knee range of movement of 0 to 131-140 degrees. Conclusion: Closed reduction with internal fixation by Enders nail can be a good alternative for management of tibia diaphysis fractures, when performed after proper patient selection and patient counselling.

Supplementation of vitamin C with atypical antipsychotics reduces oxidative stress and improves the outcome of schizophrenia

RATIONALE

Several investigators implicated role of free radical-mediated pathology in schizophrenia. No study has ever examined the effect of vitamin C with atypical antipsychotics in the treatment of schizophrenia.

OBJECTIVE

The aim of this study was to examine the effect of oral vitamin C with atypical antipsychotics on serum malondialdehyde (MDA), plasma ascorbic acid levels, and brief psychiatric rating scale (BPRS) score in schizophrenic patients.

METHOD

Forty schizophrenic patients participated in a prospective, double-blind, placebo-controlled, noncrossover, 8-week study. The patients with schizophrenia were divided randomly into placebo and vitamin C group of 20 each. Serum MDA and plasma ascorbic acid were estimated by methods of Nischal and Aye, respectively.

RESULT

Increased serum MDA and decreased plasma ascorbic acid levels were found in schizophrenic patients. These levels were reversed significantly after treatment with vitamin C along with atypical antipsychotics compared to placebo with atypical antipsychotics. BPRS change scores at 8 weeks improved statistically significant with vitamin C as compared to placebo.

CONCLUSION

Oral supplementation of vitamin C with atypical antipsychotic reverses ascorbic acid levels, reduces oxidative stress, and improves BPRS score, hence both the drugs in combination can be used in the treatment of schizophrenia.

Electrophoresis and immuno electrophoresis in leprosy

50 cases of leprosy belonging to various subgroups i.e. 10 tuberculoid, 25 lepromatous leprosy, 10 lepra reaction, 5 dimorphic leprosy, and 25 cases or normal individuals were subjected to agar gel electrophoresis. The slides were scanned by densitometry. It showed profound departure from normal in various fractions of electrophoretic patterns. All of them showed rise of gamma globulin. Albumin was markedly decreased in lepromotous leprosy and lepra reaction. In dimorphic leprosy Alfa-1 was decreased. Qualitative immuno electrophoresis was done by using antihuman serum raised in the laboratory, by immunising rabbits. It revealed changes in IgM and IgG arcs. Results are discussed and tried to explain on immunological derangement.