ABSTRACT
Background: Tuberculosis of spine constitute nearly 1% of overall cases. Surgery is indicated in selected cases, and medical care is the key treatment. The duration of anti tubercular drug therapy in spine TB is controversial. Objective: - The purpose of this retrospective and prospective study was to see the incidence, diagnose, monitor the treatment duration and complications in patients with tuberculosis of spine. Study Design - From April 2013 to October 2014 one hundred and twenty one patients with TB of the spine were admitted and treated in our institution. Methods: The patients were carefully monitored and followed up. Those who had an indication for surgical decompression were managed accordingly. For assessment we used visual analogue scales to report the level of pain, Japanese orthopaedic association score and Nuricks grading to assess the neurological and functional improvement at initial and follow up visits. Results: Out of all 122 patients, 102 patients (84.4%) healed over varying period of time and 18 (14.8%) were still under treatment while the study ended. Neurological involvement was seen in 32 (26.3%) out of 122 patients at initial presentation in the form of sensory, motor or bladder bowel involvement. The duration of healing was measured from the start of ATT till it was stopped at healing and was found to be maximum in patients with involvement of the lumbar spine with a median healing of 16 months. The treatment was completed in 103 patients and ATT was stopped and the mean healing time was 14.5 months. Conclusion: We found that the most common involved level was at the lumbar spine and skip lesions were more common. There is no fixed criteria for the duration till which the anti-tubercular therapy has to be given. It should depend on the level and extent of spinal involvement.
ABSTRACT
<p><b>PURPOSE</b>Literature suggests that the lower modulus of elasticity of titanium makes it ideal for use in children compared with stainless steel. Better fracture stability was observed in association with titanium nails on torsional and axial compression testing. However, stainless steel nails are stiffer than titanium counterparts, which may provide a rigid construct when fixing paediatric femoral shaft fractures. Complications have been observed more frequently by various researchers when titanium nails are used for fracture fixation in patients with increasing age or weight. The concept of this study was to compare the functional outcome after internal fixation with titanium elastic nail system and stainless steel elastic nail system in paediatric femoral shaft fractures.</p><p><b>METHODS</b>The study was conducted on 34 patients admitted in the department of orthopaedics, LLRM Medical College & SVBP Hospital, Meerut, India from January 2013 to August 2014. We included patients aged 5-12 years with fracture of the femoral shaft, excluding compound fractures, pathological fractures and other lower limb fractures. Patients were treated by titanium (n=17) or stainless steel (n=17) elastic nail system and followed up for one year. The clinical parameters like range of motion at hip and knee joints, time to full weight bearing on the operated limb and radiological parameters like time to union were compared between two groups. A special note was made of intra- and post-operative complications. Functional outcomes were analysed according to Flynn criteria.</p><p><b>RESULTS</b>Based on the Flynn criteria, 59% of patients had excellent results, 41% had satisfactory results, and no one showed poor results. There was no clinically significant difference between the two groups with respect to time to union and full weight bearing. But the incidence of puncture of the opposite cortex while inserting the nail and trying to advance it through the diaphysis during operation is greatly different. Only one such case was observed in titanium group but five in stainless steel group.</p><p><b>CONCLUSION</b>Majority of paediatric femoral shaft fractures are now treated operatively by elastic stable intramedullary nails. Operative intervention results in a shorter hospital stay and has economic and social benefits over conservative treatment. The cost of stainless steel nail is one third the cost of titanium nail. However, the clinico-radiological results are not significantly different between titanium and stainless steel nails at one year follow-up as observed by our study.</p>