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Computerized tomography based “patient specific blocks” improve postoperative mechanical alignment in primary total knee arthroplasty

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World Journal of Orthopedics 2016年第7期7卷 426-433页

作者： raju vaishya Vipul Vijay Vikas P Birla Amit K Agarwal Department of Orthopaedics Joint Replacement and ArthroscopyIndraprastha Apollo Hospital

AIM: To compare the postoperative mechanical alignment achieved after total knee arthroplasty(TKA) using computer tomography(CT) based patient specific blocks(PSB) to conventional instruments(CI).METHODS: Total 80 knees were included in the study, with 40 knees in both the groups operated using PSB and CI. All the knees were performed by a single surgeon using the same cruciate sacrificing implants. In our study we used CT based PSB to compare with CI. Postoperative mechanical femoro-tibial angle(MFT angle) was measured on long leg x-rays using picture archiving and communication system(PACS). We compared mechanical alignment achieved using PSB and CI in TKA using statistical ***: The PSB group(group 1) included 17 females and seven males while in CI group(group 2) there were 15 females and eight males. The mean age of patients in group 1 was 60.5 years and in group 2 it was 60.2 years. The mean postoperative MFT angle measured on long-leg radiographs in group 1 was 178.23°(SD = 2.67°, range: 171.9° to 182.5°) while in group 2, the mean MFT angle was 175.73°(SD = 3.62°, range: 166.0° to 179.8°). There was significant improvement in postoperative mechanical alignment(P value = 0.001), in PSB group compared to CI. Number of outliers were also found to be less in group operated with PSB(7 Knee) compared to those operated with CI(17 Knee).CONCLUSION: PSB improve mechanical alignment after total knee arthroplasty, compared to CI. This may lead to lower rates of revision in the PSB based TKA as compared to the conventional instrumentation.

关键词： Knee Replacement Arthroplasty Patient specific jigs Conventional jigs

Spontaneous fracture of the femoral neck in preexisting avascular necrosis of femoral head in sickle cell dis-

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Chinese Journal of Traumatology 2012年第5期15卷 312-314页

作者： raju vaishya Department of Orthopaedics&Joint Replacement Surgery Indraprastha Apollo HospitalsNew DelhiIndia

Avascular necrosis of the femoral head is a known complication of femoral neck fracture but on the contrary, femoral neck fracture in a case of preexisting avascular necrosis is a very rare phenomenon. We present a case study of a 47 year old Iraqi male who developed sponaneous ipsilateral subcapital femoral neck fracture under the condition of preexisting sickle cell disease and avascular necrosis of the femoral head. The fracture was unnoticed for a few months. The patient was managed successfully byuncemented total hip arthroplasty. Postoperative recovery was uneventful and he was discharged 4 days after surgery. At 1 year＇s follow-up, the patient had normal gait and hip function, with no sign of loosening or any other complications on radiograph.

关键词： Femur head necrosis Femoral neckfractures Anemia, sickle cell

Outcome of distal end clavicle fractures treated with locking plates

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Chinese Journal of Traumatology 2017年第1期20卷 45-48页

作者： raju vaishya Vipul Vijay Vikram Khanna Department of Orthopaedics Indraprastha Apollo Hospital New Delhi India

Purpose： Fractures of the lateral end of the clavicle are relatively uncommon. These fractures are unstable due to the various deforming forces which act on the fragments as well as the small distal fracture fragment. At most times the deforming forces are not taken into consideration, and the fracture is not fixed securely. In this study, we assessed a fixation technique using the precontoured locking plates to find out whether it provided a stable fixation with good functional outcome. Methods： Totally, 32 patients with lateral end clavicle fracture （Neer＇s Type ll） were included in the study. After the informed consent and preoperative investigations were obtained, open reduction and intemal fixation was done using a 3.5 mm precontoured superior locking plate with lateral extension under general anesthesia. Postoperative X-rays were done on day I and every 6 weeks after operation, until radiological union was achieved. The postoperative pain was assessed using Visual Analogue Scale （VAS） on postoperative days 1, 2 and 10. Postoperatively arm pouch sling was given for 2 weeks followed by active mobilization. Patients were asked to do their daily routine work and avoid lifting heavy weights. The functional outcome was assessed at the end of 2nd and 6th months with the help of Disabilities of the Arm, Shoulder and Hand （DASH} scoring. Results： There were no intraoperative complications in the procedure. The mean VAS score on post- operative day 1 was found to be 5 which decreased to 3 on day 2 and 0 on day 10. The mean DASH score was calculated as 11.63 at the end of postoperative month 2 and then 4.6 at the end of month 6. There was one case of malunion in whom the overhead abduction was restricted but was not painful and was managed conservatively. Conclusion： The precontoured locking plates with lateral extension may be a good method to fix the fractures of the lateral end clavicle, which provide a stable fixation with good functional outcome with very few instan

关键词： Lateral end clavicle fractures Precontoured locking plates Functional outcome

Dislocation of a constrained total knee arthroplasty with patellar tendon rupture after trivial trauma

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Chinese Journal of Traumatology 2015年第4期18卷 241-244页

作者： raju vaishya Vipul Vijay Abhishek Vaish Orthopedics and Joint Replacement Surgery lndraprastha Apollo Hospitals Sarita Vihar Mathura Road New Delhi 110076 India

Constrained total knee prostheses are used in knees with severe deformities and insufficiency of collaterals to provide stable and mobile knees. Dislocation after constrained knee prosthesis is an extremely rare and dreaded complication. When dislocation is associated with patellar tendon rupture, the management includes restoration of the extensor apparatus along with a stable knee. Repair of the patellar tendon is challenging due to poor soft tissue coverage in the area and a bulky repair can put tension on the wound closure. Ideal method of restoration of the extensor apparatus is a matter of debate. There are various modalities used ranging from primary end-to-end repair, augmentation by medial gastrocnemius flap, semitendinosus and synthetic implants and allograft tendoachilles. We report a rare case of a posterior dislocation of a constrained total knee arthroplasty in association with patellar tendon rupture due to a minor fall after a few weeks of surgery. The first episode was managed by reposition of the dislocation and V-Y plasty of the quadriceps and primary repair. The second episode of dislocation with re-rupture needed augmentation by semitendinosus along with the insertion of the thicker insert. The management of this complex problem along with the review of literature is discussed in this case reoort.

关键词： Dislocations Patellar ligament Arthroplasty Replacement Knee

Anterior cruciate ligament reconstruction in a 75 years old man： a case report with review of literature

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Chinese Journal of Traumatology 2014年第2期17卷 121-124页

作者： raju vaishya ~, Radhey Shyam Dhiman, Abhishek Vaish Department of Orthopedics Indraprastha Apollo Hospitals New Delhi 110076 India

Anterior cruciate ligament （ACL） reconstruction is usually recommended for young patients. Several recent articles have however reported comparable outcomes of ACL reconstruction between youth and patients in fourth or fifth age group. But in the literature there are not many reports about ACL reconstruction in patients over 70 years old. We report a case of a successful arthroscopic ACL reconstruction （using single bundle quadrupled hamstring graft） in an active 75-year-old medical practitioner. Successful outcome after ACL reconstruction can be achieved in selected older patients; chronological age is no barrier.

关键词： Anterior cruciate ligament reconstruction Knee Age factors

A Galeazzi-variant type fracture-dislocation in adults

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Chinese Journal of Traumatology 2013年第6期16卷 344-346页

作者： raju vaishya Sundar Kumar Shrestha Abhishek Vaish Department of Orthopaedics Indraprastha ApolloHospitals New Delhi India Department of Orthopaedics & Rehabilitation SanchetiHospital Pune India

Objective：Fracture of either radius or ulna with a dislocation either at the proximal or distal radioulnar joint （DRUJ） is not a common injury and is inherently *** we report a case series,with both-bone forearm fractures associated with dislocation of DRUJ,as a Galeazzi-variant type fracture-dislocation,and try to analyze this injury ***：The study was based on 6 patients having Galeazzi-variant type fracture-dislocation of different age （20 to 45 years）.All fractures were closed *** fractures involved the same level and three fractures were at different levels of radius and ulna *** thorough examination and investigations they were treated with limited contact dynamic compression plate without additional fixation for ***：All cases were followed up for 24 *** maximum incidence occurred in age group between 31 and 40 *** the fractures of both radius and ulna were united in average time of 12 *** of motion of wrist and elbow,supination and pronation at final follow-up were *** was no subsequent re-subluxation or dislocation of the DRUJ in any of the ***：Galeazzi variant in adult is a new undescribed pattern of forearm with wrist *** open reduction and internal fixation of both-bone forearm fractures is mandatory,followed by 3 to 4 weeks of immobilization in a cast for the healing of disrupted DRUJ.

关键词： Dislocations Radius fractures Ulna fractures Wrist injuries

Periprosthetic subtrochanteric femoral fracture in a megaprosthesis of the knee

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Chinese Journal of Traumatology 2013年第5期16卷 314-315页

作者： raju vaishya Ajay Pal Singh Abhishek Vaish Department of Orthopaedics & Joint ReplacementSurgery Indraprastha Apollo Hospitals New Delhi India Department of Orthopaedics Sancheti Institute of Or-thopaedics & Rehabilitation Pune India

We report a rare case of periprosthetic posttraumatic fracture of subtrochanteric region of femur alter a megaprosthesis of the knee, done for resistant non- union of distal femur with secondary osteoarthrosis in a 51... 详细信息

关键词： Periprosthetic fractures, Femur Femoral fractures Knee

Bilateral segmental pelvic and femoral fractures in a young female： A rare case report

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Chinese Journal of Traumatology 2016年第5期19卷 286-289页

作者： raju vaishya Amit Kumar Agarwal Nishint Gupta Vipul Vijay Department of Orthopaedics and Joint Replacement Surgery lndraprastha Apollo Hospitals New Delhi 110076 India

The management of multiple complicated injured patients remains a great challenge despite advance- ments in modern medical care. We present a rare case of bilateral unstable pelvic fractures associated with bilateral segmental femoral shaft fractures. We have proposed a mechanism of such complex injury pattern and discussed the plan of management. We believe that a timely and aggressive surgical inter- vention to fix all the major fractures soon after medically stabilizing the patient helped our patient tc overcome these serious and lethal injuries. It is necessary to establish an optimal protocol for man- agement of such complex fractures by conducting prospective and multicentric studies in the future.

关键词： Pelvis Femoral fractures Rib fractures

Virtual preoperative planning and 3D printing are valuable for the management of complex orthopaedic trauma

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Chinese Journal of Traumatology 2019年第6期22卷 350-355页

作者： Abhishek Mishra Tarun Verma Abhishek Vaish Riya Vaish raju vaishya Lalit Maini Department of Orthopaedics and Joint Replacement Surgery Maulana Azad Medical CollegeLok Nayak HospitalNew Delhi 110001India Department of Orthopaedics and Joint Replacement Surgery Indraprastha Apollo HospitalSaritaViharNew Delhi 110076India

Purpose:The technology of 3D printing(3DP)exists for quite some time,but it is still not utilized to its full potential in the field of orthopaedics and traumatology,such as underestimating its worth in virtual preoperative planning(VPP)and designing various models,templates,and *** can be a significant tool in the reduction of surgical morbidity and better surgical outcome avoiding various associated ***:An observational study was done including 91 cases of complex trauma presented in our institution requiring operative *** preoperative planning and 3DP were used in the management of these *** managing these cases were given a set of questionnaire and responses were recorded and assessed as a quantitative ***:In all the 91 cases,where VPP and 3DP were used,the surgeons were satisfied with the outcome which they got intraoperatively and *** time was reduced,with a better *** dimensional models of complex fracture were helpful in understanding the anatomy and sketching out the plans for optimum reduction and *** average score of the questionnaire was 4.5,out of a maximum of 6,suggesting a positive role of 3DP in ***:3DP is useful in complex trauma management by accurate reduction and placement of implants,reduction of surgical time and with a better *** there is an initial learning curve to understand and execute the VPP and 3DP,these become easier with practice and experience.

关键词： Three-dimensional printing Bone fractures Fracture dislocation X-ray computed tomography