Complex Proximal Malunited Tibial Plateau FractureTreated Primarily by Total Knee Arthroplasty-A Case Report.

INTRODUCTION: Post-traumaticOsteoarthritis osteoarthritis of the knee is a common complication following malunited proximal tibia fractures treated by internal fixation. Delayed treatment failed internal fixation native splinting can lead to malunited tibia plateau fractures. CASE REPORT: We report a 10-month-old malunited proximal tibia fracture with osteoarthritis of the knee joint who had underwent native splinting. The patient presented with complaints of pain over the left knee joint and inability to weight bear over his left leg for the past ten 10months. Radiographs showed malunited proximal tibia fracture. Since there were signs of osteoarthritis of the affected knee joint, it was decided to treat primarily by total knee arthroplasty. Postoperatively, the patient could walk freely without a stick and had no pain. The knee was stable and had a full range of movement. CONCLUSION: Post-traumatic knee arthritis is a dreaded complication following both conservative and surgical management of proximal tibia fracture due to immobilization and knee stiffness. The primary use of total knee replacement TKR can be considered an alternative treatment for patients with intra-articular fractures of the tibia not extending past the metaphysical area to provide the patient with a stable and pain-free joint.

Ledderhose Disease: Pathophysiology Diagnosis and Management.

INTRODUCTION: Ledderhose's disease, also known asplantar fibromatosis, is a rare benign nodular hyperplasia of the plantar aponeurosis. The disease is locally aggressive and can be managed very well conservatively. In patients who present with severe pain on weight-bearing might require surgical excision. CASE REPORT: We would like to report about a case of 40-year-old female with bilateral Ledderhose's disease. She was treated conservatively to no avail. On surgical excision of the fibrosis tissue, the patient gives complete relief of symptoms. In this paper, we would to discuss both the conservative and surgical methods adopted to prevent post-operative complications. CONCLUSION: Ledderhose disease is a rare benign aggressive disease which presents as nodules over the sole of the foot. The disease is usually manageable conservatively. Wide margin surgical excision of the nodule in severe cases will provide pain-free mobilization and prevent recurrence.

Early active motion protocol following triple Kessler repair for flexor tendon injury.

PURPOSE: To evaluate outcome of 6-strand triple Kessler repair for flexor tendon injuries, followed by early active motion rehabilitation. METHODS: 25 men and one woman (36 fingers) underwent 6-strand triple Kessler repair for flexor tendon injuries in zones 2 to 5, followed by early active motion rehabilitation. Rehabilitation was started at days 3 to 5. Patients were instructed to passively flex all the fingers with the uninjured hand and to actively retain this position for 10 seconds. Active extension within the confines of the splint was allowed. At the end of week 8, strength training was commenced until a satisfactory range of motion was regained. Outcome measures included total active motion, grip strength, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Complications such as infection and wound dehiscence were recorded. RESULTS: The mean follow-up was 1.2 (range, 1-2) years. Outcome was excellent in 24 digits, good in 4, and poor in 8. The mean grip strength was 80% (range, 60-100%) of normal in dominant hands and 60% (range, 50-65%) of normal in non-dominant hands. The mean DASH score was 15 (range, 0-52). One patient had wound dehiscence and superficial infection. CONCLUSION: Six-strand triple Kessler repair for flexor tendon injuries, followed by early active motion rehabilitation yields satisfactory results.

Dual release paracetamol in osteoarthritis of knee: a randomized controlled clinical trial.

BACKGROUND: Paracetamol is recommended as first line agent for pain management in osteoarthritis (OA) by various guidelines. The main problem associated with management of osteoarthritis is long term patient compliance to paracetamol due to its frequent dosing. OBJECTIVE: To evaluate the efficacy and safety of Paracetamol 650 mg dual release tablet twice daily (PCM 650 dual release) compared to paracetamol 500mg immediate release tablet thrice daily (PCM 500 IR) in the treatment of Knee OA. MATERIALS AND METHODS: In this randomized, open label, parallel, active controlled clinical study, 250 patients of OA knee meeting inclusion criteria were randomized to receive either PCM 650 dual release two times daily or PCM 500 IR three times daily for 6 weeks. Patients were assessed at baseline, 2, 4 and 6 weeks. Primary efficacy measures were severity of pain (Visual Analogue Scale) and Knee injury and osteoarthritis outcome score (KOOS) subscale for pain at week 2, 4 and 6. Other KOOS subscales (symptoms other than pain, function in daily living, function in sport and recreation, quality of life) and patient's and physicians global assessment of therapy were included as secondary endpoints. RESULTS: Both treatment groups showed improvement in primary endpoints at each evaluation visit. Patients receiving PCM 650 dual release showed significant improvement of pain in both primary endpoints at each study visit compared to patients receiving PCM 500 IR (p<0.001). PCM 650 dual release was significantly superior to PCM 500 IR for improvement in all KOOS subscales at each study visit (p<0.01). Less number of patients required additional rescue analgesics in PCM 650 dual release group (16% patients vs 26%, PCM 500 IR; p>0.05). Adverse effects were significantly less in PCM 650 dual release group (6% vs. 14% in PCM 500 IR; p<0.05). Patient's and physician's global assessment of therapy favoured PCM 650 dual release than PCM 500 IR (p<0.001). CONCLUSION: Patients with symptomatic OA of the knee showed a greater improvement in pain and functional capacity with PCM 650 dual release than PCM 500 IR with better tolerability.