ABSTRACT
Background Low back pain (LBP) is a global health concern. Management of LBP aims at pain relief facilitating improvement of functional ability. Non-steroidal anti-inflammatory drugs (NSAIDs) are the first line of therapy. However, the selection of NSAIDs is challenging given the range of underlying etiologies and severity. The current study aimed to compare the efficacy and safety of two available fixed-dose combinations (FDCs), namely, a dual FDC (DFC) of etoricoxib (60 mg) and thiocolchicoside (4 mg) versus a triple FDC (TFC) of chlorzoxazone (500 mg), diclofenac (50 mg), and paracetamol (325 mg). Methodology A total of 200 eligible adult subjects aged 18-70 years with a history of LBP and muscle spasm for ≤14 days and Wong-Baker Faces Pain score >4 were enrolled after obtaining written informed consent and randomized in a 1:1 allocation ratio to be treated with either DFC or TFC for 28 days. Efficacy was assessed based on the change in score from baseline (before treatment) to day 28 on the Wong-Baker Faces Pain Scale and the Oswestry Disability Index (ODI) questionnaire, as well as the proportion of subjects who improved upon treatment. Safety was assessed based on adverse events and clinical laboratory test results. Results A significant decrease in pain intensity (p < 0.001) and significant improvement in functional ability (p < 0.001) was observed after treatment with either DFC or TFC. The decrease in Wong-Baker Faces Pain score and ODI, from baseline, was comparable between the treatment groups. However, more subjects with very severe pain at baseline showed ≥30% improvement upon treatment with DFC than with TFC (~25% versus ~12%; p = 0.172). Also, significantly more crippled subjects with very severe functional disability showed improvement in the DFC group compared to the TFC group (~26% versus ~4%; p = 0.008). No adverse events or clinically relevant laboratory test results were evident. Conclusions Both DFC and TFC were comparable in efficacy and safety for the management of recent-onset LBP. However, significantly more subjects with very severe pain or functional disability showed improvement after 28 days when treated with DFC compared to TFC.
ABSTRACT
Patellofemoral dislocations are commonly encountered knee ailment. Although majority of the patients are managed conservatively, depending on the patients' demands and predisposing factors, patients with recurrent dislocations often require surgical intervention. The main aim of any surgical procedure should be to restore the anatomy of the soft tissue as well as the bony elements. We here describe a technique which combines transverse patella double tunnel technique with tibial tuberosity distalization and medicalization to reconstruct the medial patellofemoral ligament using a free autologous semitendinosus graft.
ABSTRACT
Introduction: A giant cell tumor is a locally aggressive non-cancerous tumor. It usually develops near a joint at the end of the bone. Most occur in the long bones of the legs and arms. Presently, we are considering a case of Ggiant cell tumor over lateral malleolar region with the line of management. Case Report: A 21-year-old male patient came with left ankle swelling over lateral malleolar region with subsequent episodes of pain during walking. Radiographic investigation suggestive of Ggiant cell tumour which was managed by en block resection of tumour with reconstruction of lateral malleolus using a proximal fibular graft, harvested from same side with protecting the neurovascular structures and used it as a newly reconstructed lateral malleolus with proper fixation. Conclusion: Post -operative functional outcome was estimated by using AOFAS score with radiographic evaluation of ankle mortis. Both implied a satisfactory outcome which conclude that though a giant cell tumour localized on the lateral malleolus are rare, but it can be managed by en bloc resection and restore the ankle biomechanics with a reverse proximal fibular graft.
ABSTRACT
INTRODUCTION: Osteoporotic vertebral compression fractures are a leading cause of disability and associated morbidities among Indian population. Worldwide, approximately 20% of elderly population above 70 years and 16% of postmenopausal women are suffering from it. Vertebral compression fractures should be aggressively treated with minimally invasive techniques such as Percutaneous Vertebroplasty (PVP) or Percutaneous Kyphoplasty (PKP) to minimize pain and disability associated with it. AIM: To evaluate the PVP in terms of pain reduction and restoration of functional abilities among the patients suffering from symptomatic osteoporotic vertebral compression fracture. MATERIALS AND METHODS: PVP using polymethyl methacrylate bone cement was performed between 2011 to 2013, on 25 patients admitted for symptomatic osteoporotic vertebral compression fracture in the Department of Orthopaedics, Institute of Post Graduate Medical Education and Research (IPGMER) and SSKM Hospital, Kolkata, West Bengal, India. All of them were followed up for one year. Pain and disability were evaluated with Visual Analogue Scale (VAS) and Oswestry Disability Questionnaire (ODQ) score respectively. Repeated measures ANOVA with Bonferroni post-hoc test was applied for significance testing. RESULTS: Reduction in pain was reported by 56% of patients within 10 minutes of operation. Mean VAS score at presentation was 8.24 (±1.16). It reduced to 6.31 (±1.21) and 2.38 (±0.08) at immediate postoperative period and after 12 months respectively. There was significant reduction (p<0.05) in pain, as measured by VAS score, started at immediate postoperative period to end of follow up period up to one year. Disability, measured by ODQ score, significantly decrease (p<0.05) over time from one week to 12-month postoperatively. At presentation, ODQ score was 93.01 (±4.54). It reduced to 76.84 (±3.76), one week after operation and 16.23 (±1.17), one year after operation. CONCLUSION: The PVP with polymethayl methacrylate bone cement is still a justified treatment procedure for osteoporotic vertebral compression fractures as it provides excellent pain relief, internal stability to the fractured vertebra thus preventing further collapse and progression of kyphosis, allowing the patients to regain normal activity at the earliest, and at a very reasonable cost with minimal complication.
