Girish Gadekar’s research while affiliated with Mahatma Gandhi Mission Medical College and Hospital and other places

Rectus femoris tear is rare and often overlooked in emergencies. The majority of quadriceps muscle belly injuries can be successfully treated conservatively and for less active, older populations Non-operative management is reasonable. A case report of a 19-year-old male Kabbaddi player who sustained an injury to his rectus femoris muscle belly while playing 5 months back. This young patient did not recover the functional outcome required to get back to running and participating in kabaddi despite 5 months of physiotherapy and non-operative management and had complaints of Pain over midthigh and weakness in quadriceps during hip flexion and knee extension. This leads to Hindrances in Jumping, running, and kicking movements. Tenderness over the midthigh and palpable defect with Pain upon resisted hip flexion or extension was seen.3/5 quadriceps power was noted. Ultrasound and MRI were done to confirm the clinical diagnosis. Operative treatment using the semitendinosus allograft with bio fiber reconstruction system to augment rectus femoris repair allowed immediate full passive flexion of the knee and an early graduated physiotherapy program leading to a return to running and his previous level of sport without any restrictions. Surgical treatment of rectus femoris tear seems to be a good option for Chronic tears.

The management of proximal tibia fracture has underdone significant changes in the recent years, while the main goals remain same i.e. to achieve a smooth articular surface, mechanical axis and joint stability. Recent advances in computed tomography and MRI based imaging have led to better understanding and classification of fracture and therefore better planning for treatment. This is a prospective analysis of the proximal tibia fracture managed as per 4 column 10 segment concept in view of functional outcomes. Radiological and functional outcomes using knee society score of the proximal tibia fractures operated and classified as per computed tomography based 4 column 10 segment concept were studied at 6 weeks, 3 months, 6 months and 9 months from year 2019 to 2022. Mean age of population sustaining proximal tibia fracture among males was 43.90 years and females was 48.71y with 86% predilection for male and 14% for female. Involvement of right tibia was 50 % in comparison to left tibia which was 46%, while 4% patients had involvement of both limbs. Distribution of proximal tibia fracture ; zero column -7.69%, one column- 55.77%, two column-21.15%, three column-15.38% average knee society score for proximal tibia fracture at the end of 9 months (knee score, function score) 87.65;79.54. Single incident of superficial infection was encountered managed with debridement and parenteral antibiotics. Single incident of surgical site infection managed with implant removal, debridement and parenteral antibiotics as per culture sensitivity. Single incident of common peroneal nerve palsy was encountered repaired with extended Lobenhoffer approach. Recent computed tomography based classification are very useful for fixation and deciding most suited surgical approach for proximal tibia fractures to achieve a smooth articular surface, mechanical axis and joint stability. Still, a long-term study with large study group is needed to confirm the usefulness of the same.

Introduction Patients are often instructed to avoid weight bearing on the proximal tibia for 6 − 12 weeks post-surgery to avoid fracture fixation failure. However, delayed weight bearing leads to delayed mobility, causing difficulties in daily activities; problems such as pain, limited knee ROM, reduced quadriceps muscle strength, and impaired functional outcomes are reported in long-term follow-up. This study primarily aimed to evaluate the feasibility and explore the effect size. The secondary aim was to determine the effectiveness of early weight bearing along with conventional physiotherapy on functional outcomes. Materials and methods A single-blinded pilot randomized controlled trial with 30 participants with proximal tibia type I, II, and III fractures were included; they were randomized using computer-based software. Seven patients were lost to follow-up. Group I received early weight bearing along with conventional physiotherapy whereas Group II received restricted weight bearing along with conventional physiotherapy. Assessments were made on post-operative day 3 (POD-03), at discharge, at 6 weeks, and at 12 weeks. Radiographs were recorded immediately after the operation, at discharge, and at 12 weeks. Results A full-scale RCT is feasible with an effect size between 0.3 − 0.7. A statistically significant difference (p < 0.05) was found within both groups 12 weeks post-surgery in all outcome measures; the difference was more prominent in the intervention group. A statistically significant difference (p < 0.05) was found between both the groups post-12 weeks in all outcome measures except quadriceps isometric muscle strength. Conclusion A full-scale RCT for early weight bearing along with conventional physiotherapy for patients operated for Type I, II, and III proximal tibia fracture is feasible. Early weight bearing along with conventional physiotherapy could have a positive effect on reducing patient’s pain perception and increasing knee joint mobility, quadriceps isometric muscle strength, knee function, and quality of life without any adverse effects. Trial Registration ClinicalTrialsRegistry.gov (CTRI/2022/10/046797).