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Aim: To understand the relative diagnostic sensitivity,specificity and accuracy of each modality.Introduction: Internal de-arrangement of knee requires utmostdiagnostic accuracy especially in professional sportspersonnel’s. MRI is the most advanced modality to date forsuch injuries and there is a trend among most of the patientsand treating young doctors to order for an MRI, in almost all theinjuries, obvious and occult, with the result that there is a heavyrush of workload on MRI and it is difficult to cope with the workload, resulting in a long waiting list.Method: In view of the above situation and conflicting reports,regarding the efficiency of ultrasound and total neglect ofclinical diagnosis this comparative study of clinicalexamination, ultrasonic diagnosis and MRI was conducted inour tertiary care centre, from March 2017 to March 2018, as aprospective double blind study.Results: Among the 104 patients who participated in this study106 lesions were diagnosed clinically, where in 10 lesions werefalse positives as confirmed by MRI, in only 96 cases. Resultsof ultrasound analysis were quite encouraging as it coulddiagnose IDK in 95 cases meaning only one case as falsenegative. Lateral meniscus (LM) was diagnosed clinically in 16cases, sonographically in 17 cases and by MRI in 18 cases.Medial Meniscus (MM) was diagnosed as torn clinically in 38cases, ultrasonographically and MRI in 36 cases. ACL wasdetected as torn clinically in 32 cases while 28 and 27 by USGand MRI while as PCL was detected as torn clinically in 1 andin 2 cases by USG and MRI. Medial collateral (MC) wasdetected as torn clinically in 7 cases and by USG and MRI In10 cases while as Lateral Collateral (LC) was detected as tornclinically in 2 cases while 3 by USG and MRI.Overall, sensitivity, specificity and accuracy (SSA) of clinicalexamination was 75.7%, 79.6% and 78.1%. Mean SSA ofultrasound was 96.8%, 98.4% and 97.4%. The study provesthat ultrasound is a reasonably sensitive, specific and accuratein expensive diagnostic tool and is underutilized, as in experthands its results match that of MRI.
ABSTRACT
Introduction: Fractures of distal third of tibia pose greaterchallenge to the treating surgeon, in view of its relative lack ofvascularity, as it is devoid of muscular envelope and is coveredonly by skin and tendons. Its proximity to the ankle joint makesit further complex than any diaphyseal fracture. A variety oftreatment modalities are available including non operative,external fixation, IM nailing and plating. Whereas, closedreduction and casting is known for redisplacement withresultant malunion and joint stiffness because of prolongedimmobilisation, external fixators are of utility only for compoundfractures of mid third and are known for pin track infections.Material and Methods: A Comparative prospective study oftwo procedures, for displaced fractures of distal third tibia inadults was conducted in Govt. Medical College (GMC),Jammu. 30 patients (Group A) were treated by ClosedReduction and fixation with IMIL Nailing and another 30 (GroupB) were treated by closed reduction and fixation using DistalTibial Locking Plate with MIPPO Technique. The patients werefollowed for a minimum of one year wherein the clinicalparameters, radiological progress and final functional resultswere evaluated as per American Orthopaedic Foot and AnkleSociety Score (AOFAS).Results: There was no significant difference in fracture healingtime or ambulation time. Good to Excellent results of 60% werefound in Group A and 73.3% in Group B. There were 13.3% ofpoor results in Group A as compared to 6.7% of Group B.Overall complication rate was higher in Group A. IMIL Nailinghad to be abandoned in 2 cases (6.7%) and switched on toDTLCP, due to per operative finding of medullary canal beingnarrower than 8 mm in one and curved in another. IMIL GroupA, also had 2 cases (6.7%) bent nail, 2 cases (6.7%) brokennail and another 3 cases (10%) of bent/broken locking bolts.No such implant related complications were observed inGroup B.Conclusion: IMIL Nailing is a technically demandingprocedure, requiring a thorough pre- operative work up and askilled experienced surgeon with all sizes of nails, reamers andalternative options available before contemplating it. However,DTLCP by MIPPO technique is easier to learn, is equallybiological, based on sound AO principles of indirect reductionand stabilization by extra periosteal fixed angle construct. Theprocedure has fewer per operative and postoperativecomplications and gives comparable or better results than IMILNailing. The choice of the procedure should be guided by thesite and geometry of fracture and individual experience of thetreating surgeon.
ABSTRACT
Objective: To study the association of serum magnesium level and indexes of insulin sensitivity/resistance in overweight diabetic subjects and evaluate the relationship of serum magnesium level with body mass index (BMI) in overweight diabetic subjects. Study design: This case-control study was conducted on 50 overweight type 2 diabetic patients. The overweight diabetic subjects were defined as (BMI ≥ 25.0-30.0 kg/m2) according to the criteria of World Health Organization (WHO), 2004. Diagnosis of type 2 diabetes mellitus was made according to the criteria recommended by the American Diabetes Association standards - 2012. Material and methods: The study was conducted on 50 overweight type 2 diabetic patients of either gender attending/admitted in OPD/wards of the Dept. of General Medicine, Jawaharlal Nehru Medical College and Associated Group of Hospitals, Ajmer, Rajasthan over a period of 12 months. Results: In overweight diabetic subjects, serum magnesium level were found to be low, HOMA-IR was high and QUICKI values was found to be low in comparison to normal weight nondiabetics. Serum magnesium significantly inversely correlated with BMI, plasma glucose, HbA1C, serum insulin, HOMA-IR and a positive correlation of serum magnesium with QUICKI (overweight subjects) was found in our study. Conclusion: Poor glycemic control in hypomagnesemia patients has been observed in the present study when compared with normomagnesemia patients. Hypomagnesemia may aggravate insulin resistance state in overweight subjects. This can predispose them to metabolic complication of diabetes mellitus.