ABSTRACT
Background: Fracture neck femur (FNF) is important due to its high incidence in general population. In younger patients, trauma is the major cause of fracture neck femur. Displaced fractures are usually treated by fixation with partially threaded cannulated screws (PTS) placed in a parallel pattern. In the present study, we have explored the use of fully threaded cannulated screws (FTS) for fixation of fracture neck of femur. Aim and Objectives: The aim of our study was to analyze and compare the clinical and functional outcomes of fracture neck femur treated in both groups. Materials and Methods: A prospective randomized control analysis was conducted in the Department of Orthopedics of Rajindra Hospital and Government Medical College, Patiala, Punjab between June 2019 and December 2021 on 30 patients who were admitted with neck femur fracture in the age group between 15 and 60 years. Fifteen patients were treated with FTS and 15 were treated with PTS. Subsequent hip radiographs were taken postoperatively and analyzed for various parameters such as fracture fixation, fracture union, and reduction. Regular follow-up was done by clinical examination along with the radiological examination monthly for 3 months, then at 6th month, and 9th month. The functional outcomes of fracture neck femur treated with PTS and FTS were compared in terms of blood loss, radiological union, weight bearing, functional outcomes (in terms of Harris hip score), and post-operative complications. Results: Hip function on the operated side was evaluated and compared with the normal side as per Harris hip score. About 73.3% of patients with FTS group in this study had excellent results compared to 26.6% in PTS group, fair results were found in 13.3% in both groups, 6.6% of patients had good results with FTS group as compared to 13.3% of PTS group, and 6.6% had poor outcome with FTS group as compared to 46.6% with PTS group. In our study, mean Harris hip score was 76.6 in PTS group and 85.5 in FTS group (P = 0.044). The present study indicated that there were statistically significant differences between FTS and PTS in terms of functional outcomes and complication rates such as femoral neck shortening (P < 0.05). However, no significant differences in terms of blood loss, weight bearing, and fracture union time were observed between two groups (P > 0.05). Conclusions: FNF treated with FTS is superior than PTS in terms of functional outcomes and complication rates. Both FTS and PTS are equivalent in terms of average blood loss, weight bearing, and fracture union time.
ABSTRACT
Background: Rotator cuff tendinopathy (RCT) is a main source of disability work inefficiency and overall inefficiency. Platelet-rich plasma (PRP) has been postulated to be of great advantage in the management of RCT. Steroidal formulations are base of all joint morbidities since long for inflammatory and degenerative conditions in orthopedics. Aim and Objectives: The aim of the study was to compare the effect of PRP injections versus steroid Injection (triamcinolone) in subacromial space on pain control and improved shoulder functions in patients having chronic RCT. Study Design: This study was a randomized controlled trial and level of evidence. Materials and Methods: The study was conducted in the Orthopaedics Department of GMC, Patiala on 40 patients (aged more than 18 years) who presented in emergency and Outpatient Department with symptoms of shoulder pain and decreased mobility at shoulder. The patients were divided into two groups. Every odd number of patient presenting to us was given PRP injection (Study group) and every even number patient was given inj triamcinolone (control group) along with physical therapy in both study and control group. Patient was followed up subsequently after 4-week and 12-week time for resolution of symptoms and improved pain-free activities. Outcome assessment criterion used included VAS system and Oxford Shoulder Scoring System. Results: Comparison of the patients in the two groups revealed significant difference between the groups in VAS and OSS at 4-week and 12-week follow-ups. Long-term effect was more in case of PRP group as compared to steroid formulation which was almost similarly effective acutely. Conclusion: Subacromial PRP injection was found to be more effective in long-term in improving overall quality of life, disability, pain, improved work efficiency, and improved shoulder movements in patients with chronic RCT than those treated by subacromial steroidal injection along with exercise program.
ABSTRACT
Background: Continuous passive motion (CPM) is a common strategy for early post-operative rehabilitation of patients who have undergone knee surgery. During an early recovery time following primary total knee replacement (TKR), the efficiency of the CPM approach was evaluated in this study. Aim and Objective: To determine the effectiveness of using a CPM device for individuals with poor ROM after a TKR as compared with non CPM device users. Materials and Methods: Fifty-four TKR patients were distributed into two groups. CPM and exercises were given to the study group, while exercises were given to the control group only. All individuals were assessed for mean active range of motion (AROM), mean Knee Society Score (KSS), and the Western Ontario and MacMaster Universities Osteoarthritis Index before and after surgery (WOMAC). Results: The study group’s mean AROM was 81.7 ± 15.1, while the control group’s was 75.4 ± 21.8. The Study group had a mean KSS score of 135.7 ± 19.7 points, while the control group had a score of 134.2 ± 15.7. Between the two groups, there were no statistical differences. The Study group’s KSS functional score was 64.6 ± 8.4, compared to 61.1 ± 7.5 for the control group, yet there was a statistically significant difference between the groups at hospital discharge (P = 0.008). A statistically significant difference in pain level, joint stiffness, and function was also found between the two groups (37.1 ± 12.3 points for the CPM group and 23 ± 14.1 points for the control). Conclusions: From these findings it suggests that CPM has no effect on improving clinical measures. The subjective assessment of pain level, joint stiffness, and functional ability, on the other hand, showed a substantial positive effect.
ABSTRACT
Background: Rheumatoid arthritis (RA) is an autoimmune disease that causes pain, stiffness, swelling, loss of joint function, and a rise in acute-phase reactant levels. Pain causes much discomfort in patients with RA. Disease-Modifying Antirheumatic Drugs, Non-Steroidal Anti-Inflammatory Drugs, and Glucocorticoids are commonly used to treat RA, but these medications alleviate the inflammatory process to improve short- and long-term goals of treatment. Vitamin D has immunomodulatory properties that may be effective in RA patients, suggesting that Vitamin D may have a remedial effect in these patients. Aims and Objectives: The aim of this study was to evaluate the effectiveness of vitamin D in controlling the inflammatory response thus controlling pain in patients with RA. Materials and Methods: The study analyzed 96 diagnosed cases of RA presenting to our tertiary care center. The subjects were allocated into two groups one in which Vitamin D was supplemented and other in which placebo was given. Their disease activity was measured and VAS score was analyzed at presentation and 1 month and 3 months of follow-up. Results: At presentation levels of Vitamin D were inversely correlated with disease activity. Mean VAS score decreased subsequently during the follow up from 3.2 ± 1.7 at presentation to 2.25 ± 1.12 in Vitamin D group and from 4.38 ± 1.79 at presentation to 2.67 ± 1.19 at 3 months follow-up in placebo group, respectively. Conclusion: Vitamin D supplementation did not statistically significantly improved the VAS score thus requiring the need for further research for the evaluation of Vitamin D supplementation in the treatment of RA.
ABSTRACT
Background: The knee joint gets injured commonly as it has less musculature anteriorly and due to external forces affecting knee movements in coronal and sagittal planes. Rotational injuries are also common at the knee. Aims and Objectives: We wanted to compare the diagnostic capabilities of magnetic resonance imaging (MRI) and diagnostic arthroscopy (DgAr) in the evaluation of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial meniscus (MM), and lateral meniscus (LM) injuries etc., seek correlation among both MRI and DgAr knee and find the better modality. Materials and Methods: This prospective study involved 50 patients suffering from knee joint injuries in our tertiary care teaching hospital. MRI of the knee was done in knees with internal derangement; all patients went for arthroscopy under general/spinal anesthesia. Keeping DgAr as reference, MRI was compared on parameters such as sensitivity and specificity, positive and negative predictive value plus accuracy. Results: MRI had a high accuracy i.e. 91.1%, 94%, 86%, and 92% for ACL, PCL, MM, and LM, respectively. Furthermore, it had low positive predictive value (PPV) and High PPV for meniscal and cruciate injuries. Conclusion: MRI is commonly used to evaluate various structures of the knee. In cases where clinical findings favor meniscal or ACL injuries, MRI scan prior to arthroscopic examination does not offer additional advantage. We suggest early DgAr as appropriate intervention in such cases.