Percutaneous K wire fixation of fifth metacarpal neck fracture--new and simple technique.

BACKGROUND: Isolated fractures of metacarpals and phalanges are the commonest injuries affected upper extremity, which constitute about 10% of skeletal fractures in general. Fifth metacarpal (boxer's fractures) being the most common. The objective of this study was to investigate the outcome of treatment of the displaced neck and sub-capital fractures of the fifth metacarpal by percutaneous K wire fixation. METHODS: An observational study was conducted in the department of orthopedics Patan hospital as an outpatient procedure from January 2010 to January 2012. All adult patients with unilateral fracture of neck of fifth metacarpal bone were included. Whose physis was open, having previous hand injury or diseases causing deformity or impaired hand function and when fracture was more than 7 days old, were excluded from the study. RESULTS: Twenty eight of 35 patients obtained anatomic reduction, and 7 patients had 2/3 apposition of bone end and no rotational deformity. Follow-up was available for only 30 patients. The follow-up time was up to 12 weeks. The head/shaft angle of the fifth metacarpal was 60.60 degrees ±9.39 degrees preoperatively, and 14.20 degrees ±7.32 degrees postoperatively, and 15.60 degrees ±6.95 degrees in 12 weeks postoperatively. The difference between preoperative and postoperative angles was highly significant. The range of motion of the metacarpal joint was 86.73 degrees ±6.13 degrees postoperatively, which was not significantly different compared with that of uninjured side which was 90.93 degrees ±3.18. The difference between preoperative and postoperative angles was highly significant. The range of motion of the metacarpal joint was not significantly different compared with that of uninjured side. The average union time was 5.46 weeks ±1.22. CONCLUSIONS: This method under consideration does not disturb the fracture site itself, the Kirschner wire being introduced in retrograde fashion makes it easier to correctly place the wire, which gives reasonably stable fixation, gives excellent results in a high proportion of selected cases. Local anesthesia is an added advantage.

Calibration of biokinetic model for acetate biodegradation using combined respirometric and titrimetric measurements.

Simultaneous storage and growth model has recently gained increased acceptance among researchers that can better interpret the processes occurring in activated sludge processes during aerobic biodegradation of organic carbon. The model underwent further improvement and was successfully calibrated using respirometric measurements, acetate being a test substrate. However, model based interpretation of titrimetry needs to be verified for proper validation of this model since pH and dissolved oxygen dynamics occur simultaneously in a batch reactor. Hence, in this paper, it is aimed to modify the existing model by introducing stoichiometric parameters involved in titrimetry in each step of the growth and storage phases along with the consideration of non-linear carbon dioxide transfer rate in liquid phase. The model calibration was done for three different acetate concentrations using titrimetric, respirometric and combined respirometric-titrimetric measurements. The parameter estimation results from all three combinations were found to be very close that supports the validity of the model.

Assessment on activated sludge models for acetate biodegradation under aerobic conditions.

A comparison of four different established models along with parameter estimation was carried out in order to explain the aerobic biodegradation of acetate in an activated sludge system. These models were investigated using experimental OUR data from batch experiments of three different concentration studies. Model calibration reveals that ASM1 model is not suitable to explain the observed experimental OUR during the famine phase implying storage compounds could play an important role during that stage. Besides, the model corresponds to the accumulation concept and is not well fitted for all concentrations studies though it includes the storage phenomena. Both the ASM3 model and the model for simultaneous storage and growth on substrate can well describe the acetate biodegradation process, however the OUR data alone is not sufficient to justify the suitability of those models. Simulated profiles using the model outputs demonstrate that storage is overestimated while ammonia degradation is underestimated in ASM3 compared to simultaneous growth and storage model. The current study also gives reasonable outcomes related to parameter estimation as compared with previous study which is statistically interpreted in this paper.

Subperiosteal osteoid osteoma of the neck of talus.

Juxta-articular, subperiosteal osteoid osteomas arising around the ankle are unusual. Tumors arising on the neck of the talus commonly produce symptoms mimicking monoarticular arthritis. Patients are usually treated for arthritis or ankle sprain, which often leads to a delay in definitive diagnosis. Here we present a case of osteoid osteoma of neck of talus which was presented as ankle pain. It puzzled us until MRI was done. Diagnostic dilemma and delay can be avoided by high index of suspicion. The patient was treated with open removal of the tumor. We also present brief review of literature about juxta-articular, subperiosteal osteoid osteoma which is uncommon from the typical osteoid osteoma occurring elsewhere in the body.

Manipulation under local anesthesia in idiopathic frozen shoulder--a new effective and simple technique.

Manipulation under anesthesia has been used to speed up the recovery of frozen shoulder (FS), which is said to be a self-limiting disease. This is a randomized prospective clinical trial performed in a tertiary care hospital. Thirty-one patients with idiopathic unilateral frozen shoulder underwent suprascapular nerve block and intraarticular local anesthesia with Methyl prednisolone acetate followed by manipulation of the glenohumeral joint. Differences in range of motion and pain were assessed before manipulation and at 7 days 6 weeks and 12 weeks. Passive range of motion increased significantly for abduction, external rotation, and internal rotation. Significant decrease in visual analogue pain (VAS) scores between initial and follow-up assessments was observed. Our results revealed that manipulation under suprascapular nerve block and intra-articular local anesthesia is a very simple, safe, cost effective and minimally invasive procedure for shortening the course of an apparently self-limiting disease and can improve shoulder function and symptoms quickly.