Functional Outcome of Paediatric Diaphyseal Fractures of Femur Treated with Closed Reduction and Multiple K Wire Fixation.

Background: Diaphyseal fracture of the femur in children is one of the common causes of paediatric morbidity. These fractures in children above the age of five years, depending upon the fracture personality, can usually be managed satisfactorily using different intramedullary implants, including Kirchner wires, Rush nail, as well as extramedullary implants using various combinations of plates and screws. Each of these methods of fracture fixation has its own merits and demerits. The current study is aimed at assessing the efficacy of internal fixation of these fractures using closed reduction and percutaneous ‘K’ wire fixation. Methods: Twenty six (n=26) children with a mean age of 7.2 years (range 5-14 years) were treated using closed reduction and multiple percutaneous K wire fixation under image intensifier. The minimum follow up period was twelve months. The final clinical and radiological assessment of patient was done at the end of one year. Three patients (n=3) were lost to final follow-up and were excluded from the final statistical calculations. Results: Twenty one fractures (n=21) united at an average time interval of 4.1 months (range 3- 6.5 months). Two patients had delayed union and one had malunion. Superficial wound infections were seen in two (8.7%) patients. Impingement of bent k wires was felt by another two (8.7%) patients. Stiffness of the knee joint was seen in three patients (13%) during follow-up. Out of three (n=3) patients with knee stiffness two responded well to vigorous physiotherapy programme, while one (n=1) patient had limited knee range of motion even at the final follow-up. Malunion was seen in one (n=1) patient. Conclusion: Closed reduction and percutaneous K wire fixation is a safe, economical, technically non-demanding and highly efficacious technique for the treatment of paediatric femoral diaphyseal fractures.

Tuberculous dactylitis: A case report.

Tuberculous dactylitis (TD) is an uncommon presentation. It is also known as spina ventosa. Mycobacterium tuberculosis is the causative agent responsible for Tuberculosis. We here present a case of a young adolescent female presenting with complaints of pain and swelling in middle finger region for the last seven month. She was diagnosed as case of tubercular dactylitis and was managed surgically along with anti-tubercular chemotherapy.

Post Partum Pubic Diastasis: A Case Report.

Post-partum pubic symphysis diastasis is termed as abnormally wide gap between the two pubic bones following vaginal delivery. It is a rare and under diagnosed condition following acute pelvic pain. We are presenting a case of post partum pubic diastasis, in a 31 year old female with complain of pain, tenderness over pubic area and unable to walk. Patient was diagnosed with x-ray and MRI and treated surgically.

Severe Hallux Varus; an Uncommon Deformity —A Case Report and Review of Literature.

Hallux varus is relatively uncommon and few cases have been reported in the orthopedic literature. In this article, we report the case of a 63 years old, female patient with severe hallux varus deformity, associated with deformity of other toes. Here we describe the case report of hallux varus managed by surgical intervention at our tertiary care hospital in Mumbai, India.

Tuberculosis of Medial Cuneiform: A Case Report.

Isolated tuberculosis of cuneiform is rare in literature. Diagnosis of tuberculosis of cuneiform remains a dilemma because of its rarity in the lower limb. Chance of misdiagnosis and delay in diagnosis may add to morbidity. Presumptive diagnosis can be made on the basis of X-ray, MRI, histopathology of the pathological tissue, which reveals granulomatous inflammation with or without caseation. Here we are reporting a case of 15 year old girl with swelling and pain over a mid foot diagnosed as tuberculosis of cuneiform on subsequent X-ray, MRI and biopsy.

Mid Clavicular swelling; An Unusual Presentation of Clavicle Tuberculosis: A Case Report.

Tuberculosis of clavicle is one of the rarely reported pathology of skeletal tuberculosis in the literature. It is difficult to diagnose because other conditions of clavicle also presents with same confusing picture, which can lead to delay in proper diagnosis and treatment. Our case is a young adolescent female presenting with complaints of mild pain and swelling in mid clavicular region for the last six month. She was diagnosed as case of mid clavicular tuberculosis and she was managed with anti-tubercular chemotherapy.

Orally disintegrating tablets : formulation, preparation techniques and evaluation.

Oral delivery is currently the gold standard in the pharmaceutical industry where it is regarded as the safest, most convenient and most economical method of drug delivery having the highest patient compliance. Formulation of a convenient dosage form for oral administration, by considering swallowing difficulty especially in case of geriatric and pediatric patient leads to poor patient compliance. To troubleshoot such problems a new dosage form known as orally disintegrating tablet (ODT), has been developed which rapidly disintegrate & dissolve in saliva and then easily swallowed without need of water which is a major benefit over conventional dosage form. In addition, patients suffering from dysphasia, motion sickness, repeated emesis and mental disorders prefer such preparation because they cannot swallow large quantity of water. Further, drugs exhibiting satisfactory absorption from the oral mucosa or intended for immediate pharmacological action can be advantageously formulated in such type of dosage form. The popularity and usefulness of the formulation resulted in development of several ODT technologies for preparation. The current article is focused on ideal characteristics, advantages and disadvantages, formulation aspects, formulation technologies, evaluation of products and future potential. Various marketed preparations along with numerous scientific advancements made so far in this avenue have also been discussed.

Iontophoretic drug delivery: History and applications.

The goal of delivery system is to get optimal therapeutic management. But, it still remains a challenge in the field of pharmaceuticals for delivery of ionic species and some non ionic. Several transdermal approaches have been used and recently there has been a great attention in using iontophoretic technique for the transdermal drug delivery of medications, both ionic and non ionic. This technique of facilitated movement of ions across a membrane under the influence of an externally applied electric potential difference is one of the most promising physical skin penetrations enhancing method. The payback of using iontophoretic technique includes improved systemic bioavailability ensuing from bypassing the first metabolism. Variables due to oral administration, such as pH, the presence of food or enzymes and transit times can all be eliminated. This article is an overview of the history of iontophoresis, mechanism, principles and factors influencing iontophoresis and its application for various dermatological conditions.