ABSTRACT
Introduction: Osteochondritis dissecans of the talus is a rarecondition that can create challenges for both the patient andthe treating surgeon. Arthroscopic bone marrow stimulation(i.e. microfracture, drilling) is a well-accepted and proventechnique to allow fibrocartilage differentiation and therebyprovide infill at the site of a cartilage defect in several joints,including the ankle. The aim of our study was to examine therole of arthroscopic bone marrow stimulation techniques as ameans of treatment for osteochondral lesions of the talus.Material and methods: Thirty two ankles were identifiedbetween January 2012 and January 2020 with talus OCD thatunderwent arthroscopic bone marrow stimulation. Each lesionwas classified according to the Berndt and Harty classification.Study patients were evaluated at 6 weeks, 3 months, 6 months,12 months, and annually after surgery. Assessments via avisual analogue scale (VAS) for pain during daily activitiesand sport activity and the American Orthopaedic Foot & AnkleSociety (AOFAS) scoring system were obtained at each visit.Result: There were 25 men and 4 women of average age 35years (range 17–50) and mean body mass index (BMI) 22 kg/m2 (range 20–34) at the time of surgery. Quantitative MRImeasurements on 3D FSPGR Sequence showed that meanarea of the lesions were 0.801 ± 0.505 cm2. Mean AOFASscores improved from 66 points (range 53–77) preoperativelyto 90 points (range 83–100) at final follow-up (p<0.05) andmean Visual Analogue Scale (VAS) scores from 6 points(range 5–8) to 2 points (range 0–5) with p value <0.05 whichis statistically significant.Conclusion: Arthroscopic management of osteochondrallesions of the talus has the advantages of better cosmeticresults, less pain, and less surgical trauma. This techniqueis technically demanding and should be reserved for theexperienced foot and ankle arthroscopist.
ABSTRACT
Introduction: A lack of bone stock, deficient medial cupsupport and medial & proximal migration of the joint centerare the main challenges in treating cases of protrusio acetabuliwith end stage arthritis. The purpose of this prospective studywas to assess the functional outcome, radilogical parameters& complications related to uncemented total hip arthroplastyin these patients.Material and methods: From November2017 to December2019, 20 patients (33 hips) with secondary acetabularprotrusions (25 grade II & 8 grade I) with end stage arthritisunderwent uncemented total hip arthroplasties with or withoutautologous bone grafting. The Harris hip scoring systemwas used to evaluate hip function during follow-up. X-rayswere taken to assess the prosthesis loosening, bone grafthealing, cup inclination angle & comparing various pre andpostoperative radiological parameters.Results: The operation time ranged from 60 to 120 min (mean=77.12 ± 14 min). The blood loss was 200 to 400 mL (mean= 252 ± 49.5 mL). The average follow-up duration was 1.5years (range 6m-2yrs). Postoperative X-rays revealed bonegraft union at 6 months post-surgery. The Harris hip scoresincreased from 34.07 ± 11.43 to 86.22 ± 6.85 postoperativelythat was statistically significant (P < 0.01). The distance fromthe center of the femoral head to Kohler’s line increasedfrom 18.76 ± 3.7 mm to 20.4 ± 3.3 mm after the operation(P < 0.01). During follow-up, no hip acetabular prosthesisloosening & progression of protrusio was evident.There wasno dislocation but one case of infection and one case of sciaticnerve injury as postoperative complication.Conclusion: The use of impacted or unimpacted morselizedautograft in conjunction with porous-coated cementlessacetabular components was a technically straight forwardsolution through which the hip bio mechanics were restoredand strong fixation was achieved, thereby preventingrecurrence of protrusio in grade II or III. For grade I protrusiowith end stage arthritis only uncement THR without bonegraft was adequate.
ABSTRACT
Spinal tuberculosis is the most frequently encountered & destructive form of skeletal tuberculosis. We wanted to evaluate the advantages of transmanubrial transclavicular approach in the surgical management of the pathologies (mainly tuberculosis) at the cervicothoracic junction (C7,T1-2).METHODSFrom June 2013 to August 2019, thirty patients with tuberculosis of CTJ presented to SCBMC & H and were operated with transmanubrial transclavicular approach. Debridement with corpectomy of tuberculosis of C7-T1 and T1 vertebral bodies were followed by fusion of C6-T2 and C7-T2 vertebra respectively with the help of titanium mesh cage and anterior cervical plating. Advantages & limitations of this surgical approach were evaluated retrospectively. Visual analogue scoring & Frankel scoring were used for assessing postoperative clinical outcome.RESULTSAll 30 cases were of tuberculosis of CTJ involving either C7-T1 or T1-T2. They presented with a permutation combination of upper thoracic pain, paraparesis, and collapse of vertebra & cord compression. All patients were followed up for 12.37 ± 5.38 months on average (range 4 -24 m). The mean postoperative visual analogue scale score was 7.86 ± 1.02 (range 6-10) preoperatively, which improved to 3.27 ± 0.88 (range 0-5) postoperatively at final evaluation (p<0.005). There was also postoperative increase in Frankel score in seventeen cases (56%). Three patients developed temporary hoarseness postoperatively, two cases got infected (one superficial & one deep) & one patient died. There was no non-union or persistent pain at manubrium or clavicle end.CONCLUSIONSThe transmanubrial transclavicular approach for tuberculosis of CTJ lesions can achieve favourable clinical outcomes by providing wide exposure, direct decompression of lesions, fusions and less complications as compared to standard approaches.
ABSTRACT
Objective :To study the clinico-social risk factors for preeclampsia in a tertiary care hospital in Bhubaneswar, Odisha. Methodology :Acase control study was done in a tertiary care hospital in Bhubaneswar. Clinical and socio-demographic data was collected from 167 inpatients with preeclampsia and similar number of controls and was analysed. Results : Majority of the women(63.9%) belonged to the low socioeconomic class with low education level. More than half were overweight(57.3%) and 61% of them were primipara. A significant number of patients(18.5%) gave a previous history of preeclampsia. Insulin resistance also presented as a risk factor. Conclusion: Though the aetiology of preeclampsia still remains obscure, there are certain risk factors which have remarkable association with the prevalence of the disease. Understanding these will enable the clinicians for early diagnosis and timely intervention.