ABSTRACT
Objective: To determine the association between shoulder impingement and morphological characteristics of acromion and the role of sub-acromial injection of methylprednisolone in the short-term treatment for relieving pain and improve functional disability of these patients
Study Design: A descriptive study
Place and Duration of Study: Department of Orthopedic Surgery and Traumatology Unit-I [DOST-I], Mayo Hospital, Lahore, between November 2013 to June 2014
Methodology: All patients presented in OPD with shoulder pain were included as subjects and evaluated by clinical test and categorised using X-ray scapula Y-view. Patients with impingement syndrome were correlated with Bigliani types and offered intra-lesional injection into sub-acromial space with 2ml of xylocaine 2% and 40 mg of methylprednisolone using 22 gauge needle. The effectiveness was assessed in terms of relieving pain and good functional outcomes; and rotator cuff tear was clinically assessed among impingement positive patient. The pain was assessed using visual analogue score before and after the administration of the injection. Demographic variables for frequencies and their associations were analysed using SPSS version 20.0. Significance level was p <0.05
Results: Among the 101 cases, there was no case of tear of rotator cuff tendon on clinical assessment. Majority of the patients [58.4%] were females with mean age of 31.38 +/- 1.13 years. Majority 57 [56.4%] of the patients had acromion type II [curved], which was the most common cause of shoulder impingement. Most had moderate pain. Thirty-four patients required intralesional steroid, which relieved the pain in 31 of them
Conclusion: Shoulder impingement syndrome without tear of rotator cuff tendon was found in younger age group between 40 to 45 years, which was relieved by intralesional corticosteroid administration. These patients had type II [curved] acromion, according to Bigliani classification
ABSTRACT
Tibial bone defect lead to limb shortening and functional deficit and needs proper treatment. There are various treatment modalities for bone defect in long bone to restore length and function of the limb, i.e. bone grafting, vascularised bone graft, allograft and bone transport. Bone transport can be done through fixators [uniplaner or ring] and intramedullary nail system. This study was conducted on management of tibial non-union with Illizarov external fixator. METHOD: This descriptive study was performed on 58 patients in Agency Headquarter Hospital, Bajawar and Lady Reading Hospital, Peshawar, from January 2000 to January 2006. Patients of either gender with age between 9 to 58 years, having nonunion [clean and infected nonunion] in tibia with defect of 2 to 7cm due to trauma or firearm injury were included in the study. These patients were followed up upto one year. Outcome measures were according to the classification of Association for the Study and Application of the Method of Ilizarov [ASAMI], which is based on radiological [defect filling] and clinical [functional] findings. Out of 58 patients, 44 [75%] were male and 14 [25%] were female. Mean age was 30 years [9 to 58 years]. 38 [65.52%] patients had infected non-union while 20 [34.48%] had clean non-union. Right tibia was involved in 32 patients [51.17%] and left was involved in 26 [44.83%] patients. The cause of initial trauma was road traffic accident in 27 patients [46.55%], firearm injury in 23 patients [39.65%] and a simple fall in 8 patients [13.79%]. The length of average bone defect was 2.90 cm [200-7.00cm]. Radiological results were excellent in 33 [58.89%] patients, good in 12 [20.68%] patients, fair in 8 [13.79%] patients and poor in 5 [8.62%] patients. The clinical results were excellent in 33 patients [56.89%], good in 18 patients [31.05%], fair in 4 [6.89%] patients and poor in 3 patients [5.17%]. Ilizarov ring fixator is excellent treatment modality for tibial non-union with a defect, regarding bone union, deformity correction, infection eradication, limb length achievement and limb function but this needs prolonged learning curve for fresh orthopedic surgeons