ABSTRACT
Introduction: Patella is an important component of extensorapparatus and it has a major role in making the extension ofknee efficient. Patella fracture accounts for 1% of all fractures.Treatment options for fracture of lower pole of patella areTension Band Wiring, Circumferential Wiring or with screw ifthe fragment is large enough. Tension Band Fixation involvesboth static and dynamic forces.Objectives: To assess the functional outcome ofosteosynthesis in fracture of lower pole of patella usingTension band Wiring technique.Materials and Methods: The present study was a follow-upstudy conducted in Churu Multispecialty Hospital and ResearchCenter, Churu during Sept 2017 to April 2019. All the patientswith lower pole of patella fracture and whose age was 16 ormore were included in the study. Tension Band wiring is donein all the 15 patients under spinal anesthesia. Patients werefollowed at 1, 6 and 12 weeks after the date of surgery.Patients were evaluated according to Bostman’s method ofclinical grading of knee scoring system and patients weregraded as excellent, poor or unsatisfactory depending on thescore obtained.Results: In present study maximum patellar fractures were inage group 31 to 50 years. Most of the patients in our studywere males. All the variables like flexion loss, extension loss,pain, quadriceps atrophy, effusion, giving way andstair climbing improved in all the cases at final follow-up. Onepatient was lost to follow-up at 12 weeks. Clinical grading alsoimproved and 12 out of 14 patients had excellent scoring atfinal follow-up. Superficial infection developed in one patientand that was recovered fully after antibiotic coverage. Onepatient developed kneeling discomfort and that was alsorecovered at 12 week of follow-up.Conclusion: Osteosynthesis using tension band wiringtechnique is a viable treatment option lower pole fracture ofpatella with good functional results despite the technicaldifficulty associated with this procedure.
ABSTRACT
Background: Acute kidney injury (AKI) is a clinical conditionoften seen in the neonatal intensive care units. The incidenceof AKI in neonates treated at the NICU ranges from 2.4 to 56%. Many etiological factors predispose development of AKI inneonates. AKI has a significant impact on survival rates,especially in preterm infants and Neonates with AKI have veryhigh mortality rates (4.5–78 %). Our understanding of AKI inLBW newborns is mostly limited to retrospective studies. So weplanned a prospective study in preterm babies with AKIdiagnosed by Koralkar criteria.Objectives: To find proportion of preterm babies (<37 weeksof gestation) with acute kidney injury born in the hospitals andto find out demographics, co-morbidities, clinical presentation,risk factors, and outcome in preterm newborns with AKI.Materials & Methods: A Prospective study on 215 pretermbabies was conducted at Neonatal units attached to SMSMedical College, Jaipur during Feb 2015 to March 2017. Thestudy variables were analyzed using Epi-Info7 software withapplication of Mean, Proportion, Chi-square, t- test, regressionanalysis and Kaplan-Meier Survival analysis.Results and Conclusion: Out of 215 pre-term infants 36(16.7%) had AKI with maximum patients in cat.1 (11.1%). Outof 36 preterm infants with AKI 13 died and no statisticallysignificant association was found between AKI and mortalityamong preterm infants. Statistically significant association wasfound between birth weight, sepsis, HMD, MV, NEC andmortality among preterm infants. Logistic regression wasperformed to eliminate potential confounders. Our final modelincluded variables with p<0.10. After regression analysis onlybirth weight was associated with mortality among preterminfants with p=0.028. On comparing survival among pretermwith AKI and without AKI the Average Hazard Rate was moreamong preterm infants with AKI but on applying Log Rank Testno statistically significant difference was found between thesurvival probabilities of the two groups.
ABSTRACT
Objective: To assess the functional outcome (clinical andradiological) of Variable angle hip screw (VHS) in trochantericfractures of femur.Materials and Methods: The study comprised of 30 patients,with follow up at regular intervals. According to Jensen andMichaelsen’s modification of Evan’s classification, 16 patientswere of stable patterns and 14 were of unstable patterns.Parameters which were evaluated during folow-up includedtime to partial weight bearing, time to full weight bearing,radiological union, mobility of the patient at 3 months and at 6months postoperatively.Results: Duration of surgery was <50 min in 14(46.7%)patients, 51-60 min in 11 (36.7%) patients in and >60 min in 5(16.6%) patients. Mean duration of surgery was 55 min. Rangeof duration of surgery was 48-78 min. In both stable andunstable fractures, majority of patients achieved partial weightbearing at 3-4 weeks and full weight bearing at 14-16 weeksand the difference was not significant. For Unstable groupRadiological union was achieved after 14 weeks in 50% ofpatients whereas in Stable group all patients achievedradiological union before 14 weeks and the difference wasstatistically significant (X2=12.293, df=3, p=0.008). Nosignificant difference was found among both the groups inmobility at 3 months and at 6 months. According to ModifiedSchatzker-Lambert score done at 6 months after surgery;excellent result occurred in 23 cases (76.7%) , good resultoccurred in 5 cases (16.7%),fair result occurred in 2 cases(6.6%)Difference in Modified Schatzker- Lambert Score forboth groups was statistically significant (X2=7.028, df=2,p=0.03).Conclusion: Variable angle hip screw (VHS) can beconsidered an effective method of treating trochantericfractures in terms of functional outcome.