Epidemiology of Orthopaedic Fractures and Other Traumatic Injuries among Patients Admitted in a Tertiary Care Hospital: An Observational Study

Background: Orthopaedic fractures and traumatic injuries are a growing concern for healthcare systems worldwide. Road Traffic Accidents (RTA) are among the top five causes of illness and mortality in South East Asian nations. Trauma caused by other factors, such as accidents at work or home, falls, and assaults, significantly contribute to overall mortality and morbidity. This study aims to investigate the occurrence of traumatic injuries with associated factors and find significant orthopaedic fracture patterns. Material & Methods: This study was a retrospective observational study that was conducted on 208 patients who were admitted to the department of orthopaedics at Dhaka Medical College and Hospital during the study period between April 2004 and June 2007 those who fulfilled the selection criteria were enrolled in this study. All data were processed and analyzed with the help of SPSS (Statistical Package for Social Sciences) version 25. The data were expressed as frequency and percentage in tables and graphs. Results: During the study period total number of study patients were 208 where 131 (62.98%) patients were male, and 77(37.02%) were female. The majority, 53 (25.48%) of the patients, were aged between 31-40 years. RTAs were responsible for 92 cases (44.23%) of all traumatic orthopaedic injuries and followed by falls accounting for 42 patients (20.19%) of injuries. Majority 46(22.12%) of the patients had fractures in femur, second majority 38(18.27%) patients had fracture in tibia/fibula. The most common fracture site being the lower limbs (58 cases, 27.88 %). Conclusion: The study concluded that the incidence of traumatic orthopaedic injuries was higher in young male adults compared to all other study groups. The three most frequent causes of injuries were falls, RTAs, and assaults were the most prevalent form of injury. The most frequently damaged bones are the femur and tibia/fibula.

Role of Non-Real Time Imaging in Improving Success of Blind Inter-Laminar Epidural Injection for Treatment of Symptomatic Prolapsed Lumbar Inter-Vertebral Disc

One of the most commonly employed methods of treatment for Lumbar disc herniation with leg pain is epidural steroid injection. Of the three routes being deployed, inter-laminar approach is preferred as needle entry can be directed more closely to the assumed site of pathology, requiring less volume than the caudal route and it is less risky compared to the trans-foraminal approach. For effective placement of the spinal needle in the epidural space, use of C-arm is a must. But, the operation theatre and C-arm is not available in most of the health centers in the developing countries especially in rural settings. Time taken to set up is another issue. To improve the success rate of needle placement in “blind method” of ILESI, we have developed a technique of using digital X-ray of lumbo-sacral spine, which is available universally nowadays, to measure the depth of the epidural space and level of the targeted inter-vertebral space. Objective: To assess the effectiveness of measurements in plain roentgenograms of lumbo-sacral spine in guiding needle placement into epidural space. Methods: A prospective study was taken up in the Dept. of PMR, JNIMS during the period May 2017- Feb 2018. 56 consecutive clinically diagnosed prolapsed PIVD patients were enrolled. Lengths of spinous process and skin thickness were measured using a caliper. A 22G Quincke needle was advanced to the expected depth given by digital xray measurement. 1 ml of Iohexol dye was injected. Position of needle was checked by C-arm x-ray. Results: Out of the total 56 subjects, 46 (82.1%) completed the treatment program. Needle was placed at proper depth in 36 cases by using Xray measurement, giving success rate of 87.8%. Mean (SD) depth of epidural space from skin was found to be 3.82 (o.74) cm as measured from X-ray and actual measurement confirmed by fluoroscopy was 3.9 (0.81) cm (Pearson’s correlation coefficient =0.86). Conclusion: Measurement of depth of epidural space using plain X-ray of LS spine improves the success rate of blind MILESI from around 50% to 87.8%. This method of non-real time imaging is cost effective in developing countries where C-arm X-ray facilities are not available

Analysis on therapeutic effect of radiofrequency ablation on discogenic lumbar spinal nerve posterior branch neuralgia after vertebral endoscope surgery / 中国中西医结合急救杂志

Objective To observe the clinical efficacy of radiofrequency ablation for treatment of discogenic lumbar spinal nerve posterior branch neuralgia after vertebral column endoscope operation. Methods Thirty-six patients with discogenic lumbar spinal nerve posterior branch neuralgia after vertebral column endoscope surgery admitted to the Affiliated Hospital of Logistics University of People's Armed Police from December 2011 to December 2017 were enrolled. According to difference in therapeutic methods, they were randomly divided into two groups, 18 cases in each group. The radiofrequency ablation group was treated with X-ray imaging guided lumbar spinal nerve posterior branch radiofrequency thermo-coagulation; the drug group received oral diclofenac sodium conservative treatment, 75 mg twice daily for 3 weeks. Both groups were followed up for 6 months, visual analogue scores (VAS) were used to evaluate the pain before and after treatment, the Oswestry dysfunction index was used to assess the degree of lumbar function recovery, and the surgical complications and adverse drug reactions were observed. Results The VAS scores in the two groups were similar before treatment; after treatment for 1 month, the VAS scores in both groups were significantly lower than those before treatment (radiofrequency ablation group: 1.83±0.71 vs. 5.67±0.77; drug group: 2.22±0.43 vs. 5.28±0.67, both P < 0.05); after treatment for 3 months and 6 months, the VAS scores were increased gradually, however, the scores of radiofrequency ablation group were significantly lower than those in the drug group (3 months was 2.00±0.59 vs. 3.39±0.70, 6 months was 2.17±0.51 vs. 3.61±0.50, both P < 0.05), moreover, the excellent and good rates of postoperative pain efficacy and of Oswestry dysfunction index improvement in the radiofrequency ablation group were significantly higher than those in the drug group [excellent and good rates of postoperative pain efficacy: 94.44% (17/18) vs. 22.22% (4/18), excellent and good rates of Oswestry dysfunction index improvement: 77.78% (14/18) vs. 44.44% (8/18), both P < 0.05]. There were no complications of infection and spinal nerve anterior branch injury in the radiofrequency ablation group, and 6 patients in the drug group presented mild gastric discomfort, which was relieved after symptomatic treatment. Conclusion The radiofrequency ablation is an effective method for treatment of discogenic lumbar neuralgia after vertebral column operation, compared with the conservative therapy, the ablation is more effective to relieve pain for a long time, promote the recovery of neural function, and the operation is safe with very few adverse reactions.

Fused cervical vertebrae – Case report.

This paper aimed to report a rare case of fusion of 6th and 7th cervical vertebrae, called as block vertebrae. Block vertebrae was observed in the Department of Anatomy, SRM Dental College. The bodies of C6 and C7 were completely fused. Anterioposterior radiograph of the fused vertebrae bodies showed hypoplastic inter vertebral disc. Lateral radiograph showed partial fusion of articular processes on left but remain unfused at the right side. Congenital cervical vertebral fusion results due to non-segmentation of sclerotomes. It may be asymptomatic or may result in various clinical symptoms with limitation of neck movements. Knowledge about the variations in vertebrae especially in cervical region is essential for orthopedic surgeons, oral-maxillofacial surgeons and physical therapists for planning any surgeries involving the neck region.

Intervertebral disc cell therapy for regeneration:mesenchymal stem cell cultivation in vitro and intervention in TGF-?1 implantation in rabbit intervertebral discs / 中国矫形外科杂志

[Objective]To evaluate whether transplanted marrow mesenchymal stem cells interfered in TGF-?1 can differentiate to nucleus pulposus cells and increase the amount of proteoglycan and collagenase Ⅱ content in intervertebral discs.[Method]We used an in vivo model to investigate the feasibility of marrow mesenchymal stem cells that cultured in vitro and interfered in TGF-?1 delivery,retention,and survival in the degeneratived disc space.In 2,4,6,8 weeks we used immunohistochemical staining to determine the change of collagenase Ⅱ content;spectrophotometry to determine the change of amount of proteoglycan with Phlorglucinol;the experiment date were analyzed by SPSS 11.5 soft ware.[Result]We found MSCs could maintain viability and proliferate within the rabbit inter vertebral disc.The amount of proteoglycan and collagen Type Ⅱ content of the intervertebral in matrix synthesis in the experiment group was increased in 8 weeks.We found no changes in the modle group.[Conclusion]Our data suggest that transplanted marrow mesenchymal stem cells in vivo can survive and increase proteoglycan and collagen Type Ⅱ amount interfered in TGF-?1 in some periods,which support its potential use as a treatment of intervertebral disc degeneration.