ABSTRACT
Extra pulmonary Tuberculosis involving soft tissues and affecting the joints and surrounding structures (tuberculous arthritis) is well known. However, Tubercular myositis is a rare condition with skeletal muscle involvement without underlying osseous or extra osseous involvement in extremely rare presentation. Due to atypical presentation the diagnosis is often delayed. We report and present a case of isolated tubercular myositis of Vastus lateralis muscle in severe osteo arthritis knee patient without evidence of any primary focus
ABSTRACT
Background: Trauma is one of the leading public health problems and the most common avoidable cause of death among children and adults up to age 45 years. For every trauma, several thousand injured people seek medical attention. Survivors incur temporary or permanent impairments and disabilities resulting in human suffering, major social consequences and economic costs for the individual, families and society. Measuring outcome after the Orthopaedic surgery is important for many reasons, particularly its one measure of effectiveness of surgical treatment and support that has been offered and standard of care taken. As trauma care has improved substantially during recent decades and has led to higher survival rates there has also been an increasing focus on the patient’s perceived Health-Related Quality Of Life (HRQOL) as an outcome after trauma. Methods:A prospective cohort study of hospitalized trauma patients who were operated at our centre for different levels of injury was performed during March 2016 to June 2017.We included 200 patients on the basis of inclusion criteria who were enrolled at the outpatient department (OPD), ward & casualty. Informed consent was taken fom all patients and clearance from ethical committee was taken. Preoperative evaluation of HRQOL was done with 36 Item Short Form Health Survey (SF36) questionnaire. Same questionnaire was filled up at the time of follow up after 1 month, 3 months and 6 months. At home interviews were done in selected patients who because of some reasons were unable to come for follow up. Results: Out of 200 patients, lower limb was operated in 133 patients and 67 cases were operated for upper limbtrauma; the most commonly performed surgery being proximal femoral nailing (22 cases). The SF-36 mean score of 200 patients pre operatively was 20.50 which postoperatively at six months improved to 83.59. The highest percentage improvement was recorded for role limitation due to emotional problem.Highest percentage of improvement in SF-36 mean score was seen in 18 to 33 year age group patients (78.77%) while lowest percentage improvement was seen in 50 to 65 year age group(72.74%). Males have shown better improvement in Mean scores as compared to females. There was no significant difference in pre operative mean scores in upper limb trauma patients (20.16) and lower limb trauma patients (20.29). Patients operated with closed reduction internal fixation or external fixation had higher pre operative mean score (21.24) & post operative mean score (85.39) than those who were operated with open reduction internal fixation(19.47 and 83.99 respectively); but the percentage improvement was slightly better in open reduction cases (76.81%) than closed reduction cases (75.13%). Conclusion:The study was conducted to determine whether the patient was satisfied or not after surgery done for Orthopaedic traumatic conditions. It was noted in the study that young age group patients showed better improvement in all aspects of Health. Both physical and mental scale improvement was more in 18 to 33 year age group patients; which decreased in second age group 34 to 50 year age group and was lowest in 50 to 65 year age group patients. The study indicated better and fast improvement in male patients as compared to females. Upper limb trauma patients showed better scores and healing than lower limb trauma patients in post operative period. Patients operated with closed reduction internal fixation or external fixation had higher pre operative mean score & post operative mean score than those who were operated with open reduction internal fixation but the percentage improvement was slightly better in open reduction cases than closed reduction cases. Good functional outcome after Orthopaedic Surgery measured in the form of SF-36 is related to many variables such as Proper surgical procedure, aseptic environment and good choice of implant, timing of surgery, post operative rehabilitation program, proper psychological counseling and regular follow ups. When all the above mentioned variables are managed and planned accordingly, the surgical intervention leads to tremendous improvement in both physical and mental health of the patients which can be measured and recorded in the form of SF-36 Health survey. The study supports the requirement of proper surgical intervention against conservative treatments for the limb injuries involving major Orthopaedic trauma to achieve better long term functional outcomes.
ABSTRACT
Background: Osteoarthritis of the knee is among the most common contributing causes of global disability, prevalent in 20 to 40 % of those over 75 years of age. Total Knee Arthroplasty (TKA), today; is the final treatment option provided to patients with unsalvageable, severely arthritic, painful and deformed knees. TKA with a postoperative mechanical axis of <3º varus or valgus have better long-term survival. Despite the continuing improvement in mechanical alignment systems, it has been estimated that the error in tibial and femoral alignment of over 3° occurs in about 10% of total knee arthroplasties even when they are carried out by well-trained surgeons using the most up-to-date mechanical alignment tools. Computer Assisted TKA has shown to reduce outliers of mechanical leg axis (>3° valgus/varus deviation) compared to the conventional technique.We hypothesized that Computer Assisted Total Knee Arthroplasty will offer a good clinical and functional outcome in patients. Methods:This was a prospective study done in Department of Orthopaedics at our institute. 53 cases were taken with diagnosis of osteoarthritis of knee joint from May 2015 to June 2017. The study was prospective and observational in nature and informed consent was obtained from each patient. Clearance from scientific and ethical committee of the institute was obtained. The results of navigation assisted total knee replacements were assessed with Visual Analogue Scale, Knee society knee score and Function Score and radiologically by various component angles and Mechanical Axis Deviation. Results: Mean Mechanical Axis Deviation of 18.04° varus preoperatively (range, 15° -24°) was corrected to 0.28° varus (range 3.5° valgus- 3.3° varus) postoperatively. Mean Knee Society score improved from 2.415 (range 0-14) to 82.55 (range 50 -95), and function score from 23.40 (range, 0 -65) to 82.55(range 50-95) at minimum 12 months of follow up. The mean pre-operative VAS was 7.6 and showed linear improvement post operatively to 4.0 at 1 month, 2.37 at 3 months, 1.07 at 6 months and finally 0.64 at 12 months. The mean component angles of implants in Tibia and Femur post-operatively were measured as Coronal femoral angle – 90.025°, Sagittal femoral angle – 90.425°, Coronal tibial angle – 90.311°, Sagittal tibial angle – 88.896°. Conclusion:60.37% excellent and 30.18% good functional outcome along with significant improvements in knee society knee scores and VAS scores was reported. This suggests that computer assisted TKA is a safe, effective and reliable method to alleviate pain and correct deformities in patients with Osteoarthritis of the knee joint. The radiological assessment done Post-operatively confirmed that, CATKA is a significantly accurate tool to correct the deformities.