Atypical Presentation of Spinal Plasmacytoma with Posterior Epidural Mass and Acute Neurological Deficit

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Vol 06 Issue 1 | January 2025 | page: 40-42 | Rishab Kafley, Piyush Sharma, Siddharth S Sethy

DOI: https://doi.org/10.13107/ojot.2025.v06.i01.78

Received 11/06/2024; Reviewed 07/07/2024; Accepted 04/12/2024; Published 10/01/2025

Authors: Rishab Kafley [1], Piyush Sharma [1], Siddharth S Sethy [1]

[1] Department of Orthopaedics, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India.

Address of Correspondence

Dr. Siddharth S Sethy,
Department of Orthopaedics, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India.
Email:

Abstract

Solitary plasmacytoma of bone most commonly involves the vertebral body, often resulting in structural collapse and anterior spinal cord compression. Presentation as a posterior epidural mass without associated vertebral body destruction is exceedingly rare and poses a significant diagnostic challenge. We report a case of thoracic posterior epidural plasmacytoma presenting with acute paraplegia in a 61-year-old man. Magnetic resonance imaging revealed a dorsal epidural mass causing severe spinal cord compression in the absence of osseous involvement. The patient underwent urgent surgical decompression and spinal stabilization, followed by oncologic evaluation. This case highlights an uncommon manifestation of plasma cell dyscrasia with posterior element involvement.
Keywords: Plasmacytoma, Paraplegia, Spinal cord, Epidural, Decompression.

References

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10. Baur-Melnyk A, Buhmann S, Becker C, Schoenberg SO, Lang N, Bartl R, Reiser MF. Whole-body MRI versus whole-body MDCT for staging of multiple myeloma. AJR Am J Roentgenol. 2008 Apr;190(4):1097-104. doi: 10.2214/AJR.07.2635. PMID: 18356461.
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12. Kalampokis A, Benetos I S, Vasiliadis E, et al. (May 13, 2025) A Review of the Literature on Surgical Management in the Acute Phase of Spinal Cord Injury: Expected Outcomes and the Influence of Surgical Timing. Cureus 17(5): e84066. DOI 10.7759/cureus.84066

How to Cite this Article: Kafley R, Sharma P, Sethy SS. Atypical Presentation of Spinal Plasmacytoma with Posterior Epidural Mass and Acute Neurological Deficit. The Odisha Journal of Orthopaedics and Trauma. January 2025; 06;01:40-42. https://doi.org/10.13107/ojot.2025.v06.i01.78

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When Arthritis Meets Cavovarus: A Unique Case of Bilateral Foot Deformity Managed with Fusion and Tendon Balancing in a Non-Charcot 60 year old Patient

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Vol 06; Issue 1 | January 2025 | page: 43-47 | Shakti Swaroop, Nabin Kumar Sahu, Akilesh Panigrahy

DOI: https://doi.org/10.13107/ojot.2025.v06.i01.80

Received 26/03/2024; Reviewed 22/04/2024; Accepted 29/09/2024; Published 10/01/2025

Authors: Shakti Swaroop [1], Nabin Kumar Sahu [1], Akilesh Panigrahy [1]

[1] Department of Orthopaedic, IMS and SUM Hospital, SOA Deemed to be University, Bhubaneswar, Odisha, India.

Address of Correspondence

Akilesh Panigrahy,
Department of Orthopaedic, IMS and SUM Hospital, SOA Deemed to be University, Bhubaneswar, Odisha, India.
Email: drakleshpanigrahy@gmail.com

Abstract

Background: Cavovarus foot deformity in older adults can lead to progressive pain, instability, and secondary arthritis, particularly in the subtalar and talonavicular joints. The optimal surgical strategy for advanced arthritic cavovarus with significant structural deformity remains challenging.
Case Presentation: A 60-year-old male presented with bilateral cavovarus deformity (left > right), chronic hindfoot pain, instability, and functional limitation. Radiographs and clinical assessment confirmed rigid varus alignment and arthritic changes in the subtalar and talonavicular joints. Non operative management had failed.
Methods: We performed a staged reconstructive surgery on the more symptomatic left foot, consisting of subtalar joint arthrodesis to address painful arthritis and hindfoot malalignment, peroneus longus-to-brevis tenodesis to correct muscle imbalance and lateral instability, and a first metatarsal dorsal wedge osteotomy with Herbert screw fixation to correct forefoot varus and optimize overall foot posture.
Results: At 12 months follow-up, the patient reported significant reduction in pain, improved stability and gait, and radiographs demonstrated solid fusion with maintained alignment. Functional scores improved, and the patient resumed independent ambulation without assistive devices.
Conclusion: Combined subtalar arthrodesis, peroneal tendon balancing, and forefoot osteotomy provided stable alignment correction and durable pain relief in a rigid cavovarus foot with hindfoot arthritis
Keywords: Cavovarus , Hindfoot arthritis, Subtalar arthrodesis

References

1. Sprinchorn A, Beischer AD. Cavovarus foot surgery including a peroneus longus transfer: a 2- to 6-year follow-up. Foot Ankle Orthop. 2021;6(3):1-7. doi:10.1177/24730114211029230
2. Yokokura S, Morita S, Horibe S, et al. Association of cavovarus alignment with peroneal tendon tears. Foot Ankle Int. 2021;42(7):871-877. doi:10.1177/10711007211001027
3. Oliveira Júnior O, Fonseca Filho L, Guedes K, et al. Evaluation of the surgical treatment of subtle cavovarus foot. J Foot Ankle. 2022;16(3):215-221. doi:10.30795/jfootankle.2022.v16.801
4. Fonseca L, Lauria Filho O, Fadel G, et al. The search for the holy grail in cavovarus foot: what are we missing? J Foot Ankle. 2023;17(1):58-68. doi:10.30795/jfootankle.2023.v17.1899
5. Al-Shammari MH, Walters J, Claridge R, et al. Clinical and radiological outcomes of osteotomies with or without arthrodesis for cavovarus deformity: a case series. QJM. 2024;117(Suppl 2):ii663-ii670. doi:10.1093/qjmed/hcae175.663
6. Van der Velde D, Klimek P, Timm J, et al. Outcomes of reconstructive osteotomies and peroneal tendon balancing in rigid cavovarus foot deformity. Foot Ankle Int. 2021;42(10):1288-1296. doi:10.1177/10711007211021942
7. Krause F, Windolf M, Schwitalle M, et al. Mid-term results of triple arthrodesis for severe fixed hindfoot deformities. Foot Ankle Surg. 2018;24(6):459-465. doi:10.1016/j.fas.2017.02.003
8. Rammelt S, Zwipp H. Cavus foot reconstruction: principles and techniques. EFORT Open Rev. 2017;2(5):221-229. doi:10.1302/2058-5241.2.160092 (Still widely cited, foundational to link to current evidence.)
9. Jastifer JR, Coughlin MJ. Evidence-based management of the cavus foot. J Am Acad Orthop Surg. 2016;24(7):463-472. doi:10.5435/JAAOS-D-15-00426
10. Dwyer FC. The treatment of pes cavus by lateral displacement osteotomy of the calcaneus. J Bone Joint Surg Br. 1959. (Historical but commonly cited — you may state “classically described”).
11. Easley M, Trnka HJ, Schon LC, Myerson M. Isolated calcaneal osteotomy versus triple arthrodesis for hindfoot varus realignment. Foot Ankle Int. 2014.
12. Lin JS, Dayton P. Lateralizing calcaneal osteotomy in cavovarus foot reconstruction: a systematic approach. J Foot Ankle Surg. 2020.
13. Madan SS, Pai V, Kadir ND, et al. Corrective strategies in adult cavovarus deformity: soft tissue, osteotomy, and fusion combinations. Foot Ankle Surg. 2018.
14. Grier AJ, Myerson MS. Subtalar arthrodesis for cavovarus hindfoot deformity: indications, techniques, and outcomes. Foot Ankle Clin. 2019;24(3):527-541. doi:10.1016/j.fcl.2019.05.010

How to Cite this Article: Swaroop S, Sahu NK, Panigrahy A. When Arthritis Meets Cavovarus: A Unique Case of Bilateral Foot Deformity Managed with Fusion and Tendon Balancing in a Non-Charcot 60 year old Patient. The Odisha Journal of Orthopaedics and Trauma. January 2025; 06;01:43-47. https://doi.org/10.13107/ojot.2025.v06.i01.80.

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Chondrocalcinosis a Differential in Young Patient: A Case Report

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Vol 06 Issue 1 | January 2025 | page: 33-35 | Satya Ranjan Patra, Abhay Tyagi, Saswat Samant, Suman Sourav Mishra, Amlan Dash, Subhrajeet Dash

DOI: https://doi.org/10.13107/ojot.2025.v06.i01.74

Received 20/04/2024; Reviewed 18/05/2024; Accepted 24/11/2024; Published 10/01/2025

Authors: Satya Ranjan Patra [1], Abhay Tyagi [1], Saswat Samant [1], Suman Sourav Mishra [1], Amlan Dash [1], Subhrajeet Dash [1]

[1] Department of Orthopaedics, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, India.

Address of Correspondence

Dr. Abhay Tyagi
Department of Orthopaedics, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, India.
Email ID: abhay20tyagi@gmail.com

Abstract

Calcium Pyrophosphate Dihydrate (CPPD) crystal deposition is the hallmark of chondrocalcinosis (CC), a disorder that usually affects the elderly and manifests as inflammatory arthritis. It is indeed rare among younger patients but warrants investigation to find the underlying causes. This case report showcases a 37-year-old woman who had a history of recurrent, self-limiting knee pain for four years and right hip pain that lasted for a year. A clinical examination showed widespread tenderness and swelling in the knees. Elevated erythrocyte sedimentation rates and distinctive punctate and linear calcifications seen on radiological examination of the right hip joint and both knees were part of the diagnostic evaluation. Synovial fluid analysis revealed rhomboid or rod- shaped CPPD crystals under polarized light microscopy, confirming the final diagnosis. The initial screening for metabolic causes were negative. Conservative methods of management included physiotherapy and analgesics for pain relief. This case emphasizes the significance of taking into account CC in younger patients who exhibit radiographic evidence of calcifications and persistent joint pain, even in cases where typical metabolic risk factors are not conclusive. Appropriate patient care depends on a precise diagnosis made via synovial fluid analysis.
Keywords: Calcium pyrophosphate deposition disease, Chondrocalcinosis, Crystal-induced arthropathy, Young adult, Synovial fluid analysis.

References

1. Fiendur ÖF, Gürer G, Ay C. Akut Poliartritli Tipik Bir Psödogut Olgusu A Case of Pseudogout with Acute Polyarthritis. 2006.
2. Rosenthal AK, Ryan LM. Calcium Pyrophosphate Deposition Disease. New England Journal of Medicine [Internet]. Massachusetts Medical Society; 2016 Jun 29 [cited 2025 Aug];374(26):2575. Available from: https://doi.org/10.1056/nejmra1511117
3. Tamborrini G, Hügle T, Ricci V, Filippou G. Ultrasound imaging in crystal arthropathies: a pictorial review. Reumatismo [Internet]. PAGEPress (Italy); 2023 Dec 19 [cited 2025 Aug];75(4). Available from: https://doi.org/10.4081/reumatismo.2023.1583
4. Hameed M, Turkiewicz A, Englund M, Jacobsson L, Kapetanovic MC. Prevalence and incidence of non-gout crystal arthropathy in southern Sweden. Arthritis Research & Therapy [Internet]. 2019 Dec 1 [cited 2025 Aug];21(1). Available from: https://doi.org/10.1186/s13075-019-2077-6
5. Rajendran K, S M, S B, Subrajaa K. Chondrocalcinosis in a Hypothyroid Female, an Unforgotten Entity-A Case Report and Literature Review. 2022.
6. Rosenthal AK. Calcium pyrophosphate deposition and crowned dens syndrome [Internet]. Vol. 88, Cleveland Clinic Journal of Medicine. Cleveland Clinic; 2021 [cited 2025 Oct]. p. 206. Available from: https://doi.org/10.3949/ccjm.88a.21008
7. Елисеев МС, Zhelyabina ОV, Chikina MN. Age-related features of calcium pyrophosphate deposition disease. Rheumatology Science and Practice [Internet]. 2019 Dec 20 [cited 2025 Oct];57(6):651. Available from: https://doi.org/10.14412/1995-4484-2019-651-656
8. Falkowski AL, Jacobson JA, Kalia V, Meyer NB, Girish G, Yosef M, et al. Cartilage icing and chondrocalcinosis on knee radiographs in the differentiation between gout and calcium pyrophosphate deposition. PLoS ONE [Internet]. 2020 Apr 16 [cited 2026 Jan];15(4). Available from: https://doi.org/10.1371/journal.pone.0231508
9. Sirotti S, Scanu A, Pascart T, Niessink T, Maroni P, Lombardi G, et al. Calcium Pyrophosphate Crystal Formation and Deposition: Where Do we Stand and What Does the Future hold? Current Rheumatology Reports [Internet]. Springer Science+Business Media; 2024 Aug 1 [cited 2025 Aug];26(10):354. Available from: https://doi.org/10.1007/s11926-024-01161-w
10. Parperis K, Constantinou A. Calcium Pyrophosphate Crystal Deposition: Insights to Risks Factors and Associated Conditions. Current Rheumatology Reports [Internet]. Springer Science+Business Media; 2024 Aug 5 [cited 2026 Jan];26(11):375. Available from: https://doi.org/ 10.1007/s11926-024-01158-5
11. Finckh A, Carthy GMM, Madigan A, Linthoudt DV, Weber M, Neto D, et al. Methotrexate in chronic-recurrent calcium pyrophosphate deposition disease: no significant effect in a randomized crossover trial. Arthritis Research & Therapy [Internet]. 2014 Oct 1 [cited 2025 Oct];16(5). Available from: https://doi.org/10.1186/s13075-014-0458-4
12. Voulgari PV, Venetsanopoulou AI, Drosos AA. Recent advances in the therapeutic management of calcium pyrophosphate deposition disease. Frontiers in Medicine [Internet]. 2024 Mar 11 [cited 2025 Oct];11. Available from: https://doi.org/10.3389/fmed.2024.1327715
13. Rosenthal AK, Ryan LM. Nonpharmacologic and Pharmacologic Management of CPP Crystal Arthritis and BCP Arthropathy and Periarticular Syndromes. Rheumatic Disease Clinics of North America [Internet]. Elsevier BV; 2014 Feb 19 [cited 2026 Jan];40(2):343. Available from: https:// doi.org/10.1016/j.rdc.2014.01.010
14. Flood R, Stack J, McCarthy G. An Update on the Diagnosis and Management of Calcium Crystal Disease. Current Rheumatology Reports [Internet]. Springer Science+Business Media; 2023 May 30 [cited 2025 Oct];25(8):145. Available from: https://doi.org/10.1007/s11926-023-01106-9

How to Cite this Article: Patra SR, Tyagi A, Samant S, Mishra SS, Dash A, Dash S. Chondrocalcinosis a Differential in Young Patient: A Case Report. The Odisha Journal of Orthopaedics and Trauma| January 2025; 06;01:33-35 | https://doi.org/10.13107/ojot.2025.v06.i01.74.

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A Rare Case Report of Bilateral Neck Femur Fractures following GTCS in Chronic Kidney Disease Patient

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Vol 06 Issue 1 | January 2025 | page: 30-32| Akshaya Kumar Sahoo

DOI: https://doi.org/10.13107/ojot.2025.v06.i01.72

Received 16/04/2024; Reviewed 05/05/2024; Accepted 21/10/2024; Published 10/01/2025

Authors: Akshaya Kumar Sahoo [1]

[1] Department of Orthopaedics, Apollo Hospitals, Bhubaneswar, Odisha, India.

Address of Correspondence

Dr. Akshaya Kumar Sahoo,
Senior Consultant, Department of Orthopaedics, Apollo Hospitals, Bhubaneswar, Odisha, India.
E-mail: drakskp@gmail.com

Abstract

Introduction: Bilateral fractures of the femoral neck are extremely uncommon, especially as a consequence of generalized tonic-clonic seizures (GTCS). Such fractures typically occurs due to intense involuntary muscle contractions during seizures rather than from direct external trauma.
Fractures of the femoral neck most commonly arise from high-energy trauma in younger individuals or trivial falls in elderly patients with osteoporosis. Bilateral femoral neck fractures occurring as a direct consequence of generalised tonic–clonic seizures (GTCS), in the absence of external trauma, are exceedingly uncommon and frequently missed during initial evaluation.
Case Presentation: We describe a 54 year-old male with CKD, who presented with bilateral hip pain and inability to bear weight following a witnessed generalized tonic–clonic seizure at home. Imaging confirmed displaced bilateral femoral neck fractures. The patient underwent staged bilateral hip hemiarthroplasty with satisfactory recovery.
Discussion: This case emphasizes that patients with chronic kidney disease are vulnerable to non-traumatic fractures after seizures due to compromised bone strength, making early diagnosis and coordinated multidisciplinary management vital.
Conclusion: Bilateral neck of femur fractures following GTCS in a CKD patient is extremely rare and necessitates high clinical suspicion for prompt diagnosis and management.
Keywords: Generalized tonic–clonic seizure, Bilateral femoral neck fracture, Seizure-induced fracture, Total hip replacement

References

1. Albishi W, Alshehri R, Almuhanna A, et al. Bilateral femoral neck fractures in a 50‑year‑old patient with chronic kidney disease. Am J Case Rep. 2024;25:e942491.
2. Haddad FS, Bann S, Hill RA, Jones DHA. Rare complications of seizures in end‑stage renal disease: a case report. PubMed. 2020.
3. Moghamis IS, Mudawi A, Babikir E, et al. Bilateral femoral neck fracture following a convulsion in the presence of chronic kidney disease: a case report. Int J Surg Case Rep. 2021;89:106545.
4. Usta M, Canan E, Ersoy G, Göksel G. Chronic kidney disease presenting with bilateral spontaneous femoral neck fracture: a case report. Turk J Intern Med. 2019;1(1):30‑33.
5. Kaur A, Saini S, Cheluvaiah CS, et al. Spontaneous bilateral femoral neck and left scapula fracture in a young adult with end‑stage renal disease. Int J Res Med Sci. 2022;10(7):1542‑1544.
6. Zingraff J, Drueke T, Roux JP, et al. Pathologic femoral neck fracture due to renal osteodystrophy. Clin Nephrol. 1974;2(2):73‑75.
7. Nishino T, Sugaya H, Kikuchi N, et al. Bilateral stress fracture of the femoral neck in association with osteonecrosis of the femoral head: a case report. J Med Case Rep. 2021;15:607.
8. Haddad FS, Bann S, Hill RA, Jones DHA. Rare complications of seizures in end‑stage renal disease: a case report including bilateral femoral neck fractures and joint dislocations. Case Rep Orthop. 2020;2020:Article ID 9980.
9. Hung KH, Lee CT, Gau YL, Chen JB. Neglected bilateral femoral neck fractures in a patient with end‑stage renal disease prior to chronic dialysis. Ren Fail. 2001;23(6):827‑831.
10. Naylor KL, McArthur E, Leslie WD, et al. The three‑year incidence of fracture in chronic kidney disease. Kidney Int. 2014;86(4):810‑818.

How to Cite this Article: Sahoo A. A Rare Case Report of Bilateral Neck Femur Fractures following GTCS in Chronic Kidney Disease Patient. The Odisha Journal of Orthopaedics and Trauma| January 2025; 06;01:30-32. https://doi.org/10.13107/ojot.2025.v06.i01.72.

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Grade III Proximal Humerus GCT Treated with Excision and Reconstructed with Megaprosthesis Augmented with Prolene Mesh- A Case Report

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Vol 06 Issue 1 | January 2025 | page: 22-25 | Nirmal Chandra Mohapatra, Rajesh Rana, Eshaan Mishra, SK Gulshane Sohel, Soumitesh Sibananda Das

DOI: https://doi.org/10.13107/ojot.2025.v06.i01.68

Received 30/03/2024; Reviewed 26/04/2024; Accepted 11/11/2024; Published 10/01/2025

Authors: Nirmal Chandra Mohapatra [1], Rajesh Rana [1], Eshaan Mishra [1], SK Gulshane Sohel [1], Soumitesh Sibananda Das [1]

[1] Department of Orthopaedics, SCB Medical College and Hospital, Cuttack, Odisha, India.

Address of Correspondence

Dr. Eshaan Mishra
Senior Resident, Department of Orthopaedics, SCB Medical College and Hospital, Cuttack, Odisha, India.
Email: eshaanmishra271@gmail.com

Abstract

Background: Giant cell tumor( GCT ) of bone is a benign yet locally aggressive tumor affecting the epiphysis of long bones. Proximal humerus involvement is uncommon and presents significant reconstructive challenges, particularly in Campanacci Grade III lesions with pathological fracture.
Case Presentation: A 54-year-old female presented with pain, swelling, and inability to lift her left upper limb. Imaging revealed an expansile lytic lesion of the proximal humerus with pathological fracture. Core biopsy confirmed GCT. The patient received neoadjuvant denosumab followed by en-bloc resection and reconstruction using a proximal humerus tumor prosthesis with capsular augmentation using prolene mesh.
Results: At 2-year follow-up, the Musculoskeletal Tumor Society (MSTS) score improved from 41% preoperatively to 84%. Active abduction was 35°. There was no evidence of infection, implant loosening, or recurrence.
Conclusion: Wide resection with mesh-augmented tumor prosthesis reconstruction provides reliable local control and satisfactory functional outcome in aggressive proximal humerus GCT with pathological fracture.
Keywords: Giant cell tumor , Proximal humerus,Pathological fracture

References

1. Turcotte R, Wunder J, Isler M, Bell R, Schachar N, Masri B, et al. Giant cell tumor of long bone: a Canadian Sarcoma Group Study. Clin Orthop Relat Res. 2002;2002(397):248–258. doi: 10.1097/00003086-200204000-00029. [DOI] [PubMed] [Google Scholar]
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3. Campanacci M, Baldini N, Boriani S, Sudanese A. Giant-cell tumor of bone. J Bone Joint Surg Am. 1987;69(1):106–14. doi: 10.2106/00004623-198769010-00018. [DOI] [PubMed] [Google Scholar]
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5. Kapoor L, Banjara R, Ragase A, Majeed A, Kumar VS, Khan SA. Outcomes of major musculoskeletal oncological reconstructions using prolene mesh-a retrospective analysis from a tertiary referral centre. J Clin Orthop Trauma. 2021 Jan 4;16:195-201. doi: 10.1016/j.jcot.2020.12.029. PMID: 33717957; PMCID: PMC7920099
6. Yang Y, Li Y, Liu W, Niu X. Mesh patch and anchors can improve clinical results of prosthetic replacement after resection of primary proximal humerus malignant tumor. Sci Rep. 2021 Jan 12;11(1):734. doi: 10.1038/s41598-020-78959-y. PMID: 33436664; PMCID: PMC7804124.
7. Broida, S.E.; Salmons, H.I.; Owen, A.R.; Houdek, M.T. Outcomes of Abductor Repair Using Mesh Augmentation in Oncologic Proximal Femur Replacement. Curr. Oncol. 2024, 31, 5730-5736. https://doi.org/10.3390/curroncol31100425

How to Cite this Article: Mohapatra NC, Rana R, Mishra E, Sohel SKG, Das SS.Grade III Proximal Humerus GCT Treated with Excision and Reconstructed with Megaprosthesis Augmented with Prolene Mesh- A Case Report. The Odisha Journal of Orthopaedics and Trauma| January 2025; 06;01:22-25. https://doi.org/10.13107/ojot.2025.v06.i01.68

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Contemporary Concepts in Infection Prevention for Open Fractures: Focus on Antibiotic Prophylaxis and Surgical Protocols

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Vol 06 Issue 1 | January 2025 | page: 02-06 | Hatia Marandi, Aurobinda Das

DOI: https://doi.org/10.13107/ojot.2025.v06.i01.62

Received 15/04/2024; Reviewed 23/05/2024; Accepted 08/10/2024; Published 10/01/2025

Authors: Hatia Marandi [1], Aurobinda Das [1]

[1] Department of Orthopaedics, Hitech Medical College and Hospital, Bhubaneswar, Odisha, India.

Address of Correspondence

Dr. Aurobinda Das,
Department of Orthopaedics, Hitech Medical College and Hospital, Bhubaneswar, Odisha, India.
Email: auro.d1984@gmail.com

Abstract

Introduction: Open fractures represent a critical orthopedic emergency characterized by significant soft-tissue disruption and a high propensity for infection, which can lead to devastating complications like chronic osteomyelitis and limb loss. Despite standardized care, infection rates remain high in severe injuries, necessitating a shift toward multimodal prevention strategies.
Objective: This review explores contemporary concepts in infection prevention for open fractures, specifically focusing on the evolution of systemic and local antibiotic delivery, innovations in implant technology, and evidence-based surgical protocols.
Methods: A synthesis of current clinical guidelines (WHO, CDC, and specialty societies) and recent research (up to 2025) was conducted to evaluate the efficacy of emerging prophylactic interventions and surgical site management techniques.
Results: Findings indicate that while prompt systemic antibiotic administration (within one hour of injury) remains the gold standard, adjunctive local delivery via antibiotic-impregnated beads or powders significantly reduces infection in high-grade fractures. Furthermore, innovations such as bioactive nanostructured implant coatings and pH-triggered antibacterial layers offer promising results in preventing biofilm formation. In surgical management, the selective use of prophylactic incisional negative pressure wound therapy (iNPWT) and standardized alcohol-based skin antisepsis have demonstrated efficacy in reducing surgical site infections (SSI).
Conclusion: Effective infection prevention in open fractures requires a transition from traditional monotherapy to a comprehensive, protocol-driven approach. Future directions emphasize the need for large-scale randomized trials to standardize local antibiotic dosing and the integration of “smart” biomaterials into routine clinical practice to further mitigate the burden of fracture-related infections.
Keywords: Open Fractures, Infection Prevention, Antibiotic Prophylaxis, Implant Coatings.

References

1. Laura Roberts, Mohamed Radwan Ahmed, Devendra K. Agrawal. Current Strategies in the Prevention and Management of Infection in Open Fractures. Journal of Orthopedics and Sports Medicine. 7 (2025): 218-229.
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3. Chung HJ, Sohn HS. Fracture-related infections: a comprehensive review of diagnosis and prevention. J Musculoskelet Transl 2025; doi:10.46550/jmt.2025.00164. Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea.
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How to Cite this Article: Hatia Marandi H, Aurobinda Das A. Contemporary Concepts in Infection Prevention for Open Fractures: Focus on Antibiotic Prophylaxis and Surgical Protocol. The Odisha Journal of Orthopaedics and Trauma. January 2025; 06;01:02-06. https://doi.org/10.13107/ojot.2025.v06.i01.62

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Staged Orthoplastic Reconstruction of a Gustilo Anderson Grade IIIB Open Proximal Phalanx Fracture of the Thumb with Segmental Bone Loss

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Vol 06 Issue 1 | January 2025 | page: 18-21 | Atanu Mohanty, Anuraag Mohanty

DOI: https://doi.org/10.13107/ojot.2025.v06.i01.67

Received 19/04/2024; Reviewed 11/05/2024; Accepted 08/11/2024; Published 10/01/2025

Authors: Atanu Mohanty [1], Anuraag Mohanty [2]

[1] Department of Orthopaedics, Maharaja Jajati Kesari Medical College and Hospital, Jajpur, Odisha, India

[2] Department of Orthopaedics, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India

Address of Correspondence

Dr. Anuraag Mohanty
Postgraduate Resident, Department of Orthopaedics, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
Email: anuraag98@gmail.com

Abstract

Background: The thumb contributes approximately 40 to 50 percent of global hand function. Loss or shortening of the thumb markedly impairs pinch, grasp and fine manipulation, which makes preservation and reconstruction of severe thumb injuries a priority in hand trauma.
Case presentation: A 40 year old man sustained a Gustilo Anderson Grade IIIB open fracture of the proximal phalanx of the right thumb with segmental bone loss following a machinery crush injury. He was managed with staged orthoplastic reconstruction. The first stage consisted of meticulous debridement and provisional external fixation. The second stage used a dorsal metacarpal artery based sensate flap for soft tissue coverage. The third stage involved definitive skeletal reconstruction with tricortical iliac crest bone graft and K wire fixation.
Outcome: The flap survived, the graft united, and the patient regained a stable, pain free thumb with useful opposition and pinch.
Conclusion: A planned orthoplastic strategy that combines early debridement and temporary external fixation, reliable sensate flap cover and delayed structural bone grafting can successfully salvage high grade open injuries of the thumb with bone loss and restore functional length.
Keywords: Thumb fracture, Open fracture, Orthoplastic reconstruction, Dorsal metacarpal artery flap, Iliac crest bone graft, External fixation

References

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How to Cite this Article: Mohanty A, Mohanty A. Staged Orthoplastic Reconstruction of a Gustilo Anderson Grade IIIB Open Proximal Phalanx Fracture of the Thumb with Segmental Bone Loss. The Odisha Journal of Orthopaedics and Trauma. January 2025; 06;01:18-21.

https://doi.org/10.13107/ojot.2025.v06.i01.67

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Preoperative Physiotherapy versus No Preoperative Conditioning in Lumbar Spine Surgery: A Comparative Study of Pain, Mobility, and Functional Recovery

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Vol 06 Issue 1 | January 2025 | page: 07-13 | Birupakshya Mahakul, Narayan Chandra Mahakul

DOI: https://doi.org/10.13107/ojot.2025.v06.i01.64

Received 08/05/2024; Reviewed 02/06/2024; Accepted 19/11/2024; Published 10/01/2025

Authors: Birupakshya Mahakul [1], Narayan Chandra Mahakul [2, 3]

[1] KIMS School of Physiotherapy, KIIT-DU, Bhubaneshwar, Odisha, India.
[2] Regional Spinal Injury Centre (RSIC) Cuttack, Odisha, India.
[3] P.G. Director, Hi- Tech Medical College, Bhubaneshwar, Odisha, India.

Address of Correspondence

Dr. Birupakshya Mahakul
Principal, KIMS School of Physiotherapy, KIIT-DU, Bhubaneshwar.
Email: drbirupakshya@gmail.com

Abstract

Background: Delayed functional recovery and persistent pain following lumbar spine surgery remain significant clinical concerns despite advances in surgical techniques. Preoperative physiotherapy (prehabilitation) has been proposed as a strategy to optimize physical preparedness and accelerate postoperative recovery; however, evidence regarding its effectiveness in lumbar spine surgery remains inconsistent.
Objective: To compare the effects of structured preoperative physiotherapy versus no preoperative conditioning on postoperative pain, mobility, and functional recovery in patients undergoing elective lumbar spine surgery.
Methods: This prospective, randomized comparative study included 120 patients scheduled for elective lumbar spine surgery, who were allocated to either a prehabilitation group (PREHAB, n = 60) or a usual-care control group (NO PREHAB, n = 60). The PREHAB group participated in a six-week supervised physiotherapy program comprising aerobic conditioning, strengthening, lumbar stabilization exercises, flexibility training, and patient education, while the control group received standard preoperative care without structured physiotherapy. Primary outcome was functional disability assessed using the Oswestry Disability Index (ODI) at six weeks postoperatively. Secondary outcomes included pain intensity (Numeric Pain Rating Scale), functional mobility (Timed Up and Go test), functional exercise capacity (Six-Minute Walk Test), length of hospital stay, and postoperative opioid consumption. Outcomes were measured at baseline, preoperatively, and at 2 weeks, 6 weeks, and 3 months postoperatively.
Results: Baseline characteristics were comparable between groups. At six weeks postoperatively, the PREHAB group demonstrated significantly greater improvement in ODI compared with the NO PREHAB group (mean difference −8.5 points; p < 0.001), exceeding the minimal clinically important difference. The PREHAB group also reported significantly lower pain scores at two weeks postoperatively (p < 0.001) and demonstrated superior functional mobility and walking capacity at both six weeks and three months (p < 0.01). Additionally, patients in the PREHAB group had shorter hospital stays and reduced postoperative opioid requirements. No serious adverse events related to preoperative physiotherapy were reported.
Conclusion: Structured preoperative physiotherapy significantly enhances early postoperative recovery following lumbar spine surgery by reducing pain, improving mobility, and accelerating functional restoration. Incorporating prehabilitation into routine preoperative care pathways may represent a safe and effective strategy to optimize surgical outcomes.
Keywords: Preoperative physiotherapy, Prehabilitation, Lumbar spine surgery, Functional recovery, Pain management, Mobility, Rehabilitation

References

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13. Tarnanen S, Neva MH, Dekker J, Häkkinen K, Vihtonen K, Pekkanen L, Häkkinen A. Randomized controlled trial of postoperative exercise rehabilitation program after lumbar spine fusion: study protocol. BMC musculoskeletal disorders. 2012 Jul 20;13(1):123.
14. Bogaert L, Thys T, Depreitere B, Dankaerts W, Amerijckx C, Van Wambeke P, Jacobs K, Boonen H, Brumagne S, Moke L, Schelfaut S. Rehabilitation to improve outcomes of lumbar fusion surgery: a systematic review with meta-analysis. European Spine Journal. 2022 Jun;31(6):1525-45.
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How to Cite this Article: Mahakul B, Mahakul NC. Preoperative Physiotherapy versus No Preoperative Conditioning in Lumbar Spine Surgery: A Comparative Study of Pain, Mobility, and Functional Recovery. The Odisha Journal of Orthopaedics and Trauma. January 2025; 06;01:07-13.  https://doi.org/10.13107/ojot.2025.v06.i01.64

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Bifocal Bone Transport Using Limb Reconstruction System for Large Infected Gap Non-union of Distal Femur: A Case Report

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Vol 06- Issue 1 | January 2025 | page: 36-39 | Satya Ranjan Patra, Subhrajeet Dash, Saswat Samant, Suman Sourav Mishra, Amlan Dash, Abhay Tyagi

DOI: https://doi.org/10.13107/ojot.2025.v06.i01.76

Received 10/05/2024; Reviewed 09/06/2024; Accepted 27/11/2024; Published 10/01/2025

Authors: Satya Ranjan Patra [1], Subhrajeet Dash [1], Saswat Samant [1], Suman Sourav Mishra [1], Amlan Dash [1], Abhay Tyagi [1]

[1] Department of Orthopaedics, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, India

Address of Correspondence

Dr. Subhrajeet Dash,
Post graduate resident, Department of Orthopaedics, Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, Odisha, India.
Email ID: subhrajeetdash01@gmail.com

Abstract

Background: Large infected gap nonunion (>10 cm) following failed intramedullary nailing represent a therapeutic challenge. This case demonstrates bifocal bone transport using Limb Reconstruction System (LRS) as an effective solution.
Case Presentation: A young male presented with discharging sinus and pathological fracture 6 weeks after retrograde femoral nailing. After debridement and removal of 12 cm infected sequestrum, bifocal bone transport was performed using LRS with simultaneous proximal and distal corticotomies. Infection was controlled through debridement, antibiotic therapy, and biological advantages of distraction osteogenesis. Docking nonunion was managed by dynamization (far-far pin removal with manual compression).
Results: Patient achieved complete union with restoration of function at 18 months. Knee ROM improved from 0-80° to 0-110°.Full weight-bearing was achieved by 36 weeks. No infection recurrence or major complications.
Conclusion: Bifocal bone transport with LRS is effective for large infected gap nonunion, offering infection control, biological preservation, and accelerated consolidation with superior functional outcomes.
Keywords: Bifocal bone transport, Limb Reconstruction System, Infected nonunion, Gap nonunion, Femoral shaft, Distraction osteogenesis

References

1. Gustilo RB, Anderson JT. Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones: retrospective and prospective analyses. J Bone Joint Surg Am. 1976;58(4):453–458.
2. Tsibidakis H, Tzurbakis M, Mitsiokapa E. Bifocal bone transport over a preexisting nail to treat septic non-union of the femur with a large gap: a case report. Case Rep Clin Res. 2020;2(1–3):40–48.
3. Paley D. Problems, obstacles, and complications of limb lengthening by segmental distraction. Clin Orthop Relat Res. 1990;(250):81–104.
4. Peng C, Liu Y, Zhou M, Zhang J, Chen S, Yang Y. Evaluation of complications associated with bifocal bone transport as treatment for proximal, intermediate or distal femoral defects caused by infection: outcome analysis of 76 patients. Int J Surg. 2022;98:106239.
5. Yushan M, Yang Y, Wen G, Yang Y, Xie W, Wang G. Bifocal or trifocal bone transport using a unilateral rail system in the treatment of femoral and tibial bone defects. Orthop Surg. 2020;12(1):138–149.
6. Borzunov DY. Compression–distraction osteosynthesis in the treatment of long bone non-union. J Orthop Traumatol. 2012;13(1):1–10.

How to Cite this Article: Patra SR, Dash S, Samant S, Mishra SS, Dash A, Tyagi A. Bifocal Bone Transport Using Limb Reconstruction System for Large Infected Gap Non-union of Distal Femur: A Case Report. The Odisha Journal of Orthopaedics and Trauma. January 2025; 06;01:36-39.  https://doi.org/10.13107/ojot.2025.v06.i01.76.

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