Dual Energy X-ray Absorptiometry Scanning for Osteoporosis Detection: Analysis of Patients at a Tertiary Care Hospital.

INTRODUCTION: Dual-energy X-ray absorptiometry (DEXA) scanning is a rapid and accurate noninvasive procedure utilized to measure bone mineral density (BMD) and diagnose osteoporosis. The primary objective of this study was to assess the prevalence of osteoporosis in different regions of the body using DEXA scanning in patients attending a tertiary care private hospital. Additionally, we aimed to raise awareness about approved diagnostic methods for osteoporosis. METHODOLOGY: For this retrospective study, a sample size of 384 participants was determined. The selection of participants was based on convenience sampling, considering their availability and accessibility. Data were collected from adult patients aged 18 years and above who underwent DEXA scanning. The information was compiled using Microsoft Excel, obtained from the patient's treating physicians, and evaluated by two medical graduates. Statistical analyses were performed using IBM SPSS Statistics version 26.0 (IBM Corp., Armonk, NY). RESULTS: The findings unveiled an overarching osteoporosis prevalence of 38.5%, accompanied by distinctive figures of 38.7%, 8.9%, and 38.4% in the lumbar, hip, and forearm regions, respectively. Furthermore, the occurrence of osteopenia was found in 33% of participants in the lumbar region, 35.1% in the hip region, and 39.7% in the forearm region. Additionally, no significant association was found between gender and overall osteoporosis prevalence, suggesting that the susceptibility to osteoporosis did not significantly differ between genders. Moreover, the study emphasized the variations in bone density across different skeletal regions, with the forearm region displaying the lowest mean T-score and Z-score. CONCLUSIONS: The results of this study on osteoporosis prevalence in the lumbar, hip, and forearm regions indicate varying rates among these skeletal sites. Notably, both male and female patients demonstrated an equal susceptibility to developing osteoporosis. Interestingly, the forearm region emerged as the most common site for osteoporosis in males (34.6%), while the lumbar region was the most common in females (41.6%).

Driving reaction time following periacetabular osteotomy.

INTRODUCTION: Periacetabular osteotomy (PAO) is increasingly being used to treat young adults with symptomatic hip dysplasia. Currently there is a lack of evidence to guide return to driving after this procedure. This study aimed to identify the length of time required after a Periacetabular Osteotomy procedure before a patient can safely return to driving. METHODS: All patients undergoing PAO were assessed for suitability for the study. Inclusion criteria were: currently driving with a valid licence; and being able to attend follow-up assessment. Baseline driving reaction time was assessed using a driving simulator preoperatively. The simulation was repeated 5 times for each patient and reaction times recorded (Thinking time, Action time and Total reaction time for braking at 30 mph). The driving simulation was repeated using the same methods at 6 weeks and 12 weeks postoperatively. Pre- and postoperative times were compared. RESULTS: 26 patients were included (24 females, 2 males) with a mean age of 32 (range 19-50) years. The mean preoperative times were: Thinking time 0.48, Action time 0.21, Total time 0.69 seconds. At 6 weeks postoperatively, mean Action time increased to 0.26 seconds (p = 0.012) and mean Total time increased to 0.78 seconds (p = 0.013). By 12 weeks post procedure, there was no significant difference in reaction times compared to baseline (mean Thinking time 0.47 seconds, Action time 0.23, Total time 0.72; p > 0.05). CONCLUSIONS: Most patients may not be safe to drive at 6 weeks following PAO procedures but should be safe to drive at 12 weeks postoperatively. Individual patient factors should also be taken into consideration.

Surgical dislocation of the hip for excision of benign tumours.

AIM: Surgical dislocation of hip is used to treat a variety of hip conditions. We report our experience of the approach in excision of benign tumours of the hip. METHODS: This is a review of the cases presenting with benign tumours to a tertiary care complex hip clinic. Data was collected prospectively. All patients were radiologically investigated before surgery for anatomical detail. Surgical dislocation was carried out by the senior surgeon in all cases. Non-Arthritic Young Hip Scores were done preoperatively and at 12 months. All patients are under annual follow-up. RESULTS: There were 9 cases of benign tumours in this series including Pigmented Villonodular Synovitis (2), synovial chondromatosis (2), fibrous dysplasia (2), osteochondroma (2) and chondroblastoma (1). No recurrences, trochanteric nonunion or avascular necrosis have been seen up to a minimum of 18 months follow-up. Non-arthritic Young Hip scores improved from a mean of 45 to 89 at 12 months. CONCLUSION: Surgical dislocation of the hip is a useful approach for removal of benign tumours of the hip joint.

Psychosocial aspects of hip disease in the young adult.

The psychosocial impact of hip disease on the young adult has not been elucidated. This study aimed to identify the functional and psychosocial characteristics of a cohort of young patients (age less than 40 years) presenting to our tertiary care complex hip clinic. A postal questionnaire comprising of a Visual Analogue Scale (VAS) for Pain, the Oswestry Disability Index (ODI) and the Hospital Anxiety and Depression Scale (HADS) was posted to 63 patients. Forty-nine (n = 49) patients (79%) responded to the questionnaire. Mean age was 20 years (range 16-38) with a gender ratio of 2:1 (female: male). More than half of our patients had moderate to severe pain based on the VAS and at least moderate disability on the ODI. HADS showed that 32% and 49% of patients were classified as having borderline to abnormal levels of depression and anxiety respectively. Multiple regression showed ODI scores to be a significant predictor of anxiety and depression. Comparison with asymptomatic controls shows that these patients have significantly worse ODI and HADS scores compared to normal population. This study quantifies the degree of functional and psychosocial compromise present in young patients with hip problems.

Complications of Elastic Stable Intramedullary Nailing for treating paediatric long bone fractures.

This study reports the complications observed in children with long bone fractures treated using Elastic Stable Intramedullary Nailing (ESIN). One hundred and sixty-four (n = 164) fractures in 160 patients under the age of 16 years formed the basis of our review. This included 108 boys and 52 girls with the median age of 11 years and median follow up of 7.5 months. The analysis included fractures of the radius/ulna, humerus, femur and tibia. All pathological fractures were excluded. In this series 54 patients (34%) had complications however majority of these were minor complications with irritation due to prominent nail ends being the commonest complication. No long-term sequelae were encountered in our patients.

Evaluation of a single accelerometer based biofeedback system for real-time correction of neck posture in computer users.

The worldwide adoption of computers is closely linked to increased prevalence in neck and shoulder pain. Many ergonomic interventions are available; however, the lifetime prevalence of neck pain is still estimated as high as 80%. This paper introduces a biofeedback system using a novel single accelerometer placement. This system allows the user to react and correct for movement into a position of bad posture. The addition of visual information provides artificial proprioceptive information on the cranial-vertebral angle. Six subjects were tested for 5 hours with and without biofeedback. All subjects had a significant decrease in the percentage of time spent in bad posture when using biofeedback.

Subacromial bursa block is an effective alternative to interscalene block for postoperative pain control after arthroscopic subacromial decompression: a randomized trial.

Subacromial decompression surgery is associated with significant postoperative pain. We compared interscalene block (ISB) with subacromial bursa block (SBB). Sixty consecutive patients with subacromial impingement syndrome, scheduled for arthroscopic subacromial decompression surgery, were randomized into 3 groups receiving ISB (n = 19), SBB (n = 19), or no block (n = 15 [controls]). Patients with rotator cuff tears were excluded (n = 7). The postoperative consumption of morphine, time to the first bolus of morphine, oral analgesia, pain, sickness, and sedation scores were recorded. The pain scores in the ISB and SBB groups were lower than those in the control group in the first 12 hours postoperatively. The control group consumed more morphine (mean, 32.3 mg) compared with the SBB group (mean, 21.21 mg) and ISB group (mean, 14.00 mg) (P < .001). The time to first bolus was earlier in the control group (mean, 42.1 minutes) compared with both the SBB (mean, 92.6 minutes) and ISB (mean, 119.0 minutes) groups (P < .001). The oral analgesic intake was less in the SBB and ISB groups than in the controls (P = .004). Although ISB remains the gold standard, SBB provides effective, safe, and easily administered postoperative analgesia in patients with an intact rotator cuff undergoing arthroscopic subacromial decompression.

Avascular necrosis in acute and acute-on-chronic slipped capital femoral epiphysis.

This study reviews the factors affecting the development of avascular necrosis (AVN) after slipped capital femoral epiphysis. Seventy-three patients (n=73) with ninety-two (n=92) hips were included in the study. Out of these 92, 16 were acute, 43 acute-on-chronic, 29 chronic, and four were preslips. Postoperative radiographs showed a reduction in 18 (19.5%) slips. The mean preoperative slip angle was 32 degrees (range 9-76) compared with the postoperative slip angle of 29.9 degrees (range 10-75 degrees ) (P=0.004). Four patients developed AVN. Our results showed that intraoperative reduction of the slip (P<0.001) was significantly related to the development of AVN and was also associated with poor functional outcome.