A Comparison of Anteromedial Plating Versus Anterolateral Plating for Humerus Shaft Fractures Using the Anterolateral Approach.

Background Plate osteosynthesis is the gold standard treatment for the management of humeral shaft fractures. In the present study, we performed plate osteosynthesis on the anteromedial and anterolateral surfaces using the anterolateral approach to compare the functional outcomes. Aims and objectives To study and compare the functional outcome, time to achieve union and associated complications of anteromedial and anterolateral plating in humerus shaft fracture by anterolateral approach. Methods This prospective, randomised control study was performed at Dr Baba Saheb Ambedkar Medical College and Hospital, New Delhi, India. This study had 46 patients in total, who were divided into two equal groups at random. All of the fractures in group A were treated using a limited contact dynamic compression plate (LCDCP) on the anterolateral surface using an anterolateral approach, while all of the fractures in group B were corrected using an anteromedial surface using an anterolateral approach using LCDCP. All the patients were followed for six months at regular intervals. At each follow-up, patients were assessed radiologically with X-rays and clinically by Rodriguez-Merchan criteria (RM criteria). Results and conclusions The union was achieved in the majority of the cases of the anteromedial plating group within 12 weeks (78.3%) with a mean union time of 11.7±1.5 weeks than the anterolateral group (56.5%) with a mean union time of 12.3±1.8 weeks. Based on functional assessment according to RM criteria, the excellent outcome was achieved in 69.6% and 65.2% of the anterolateral and anteromedial plating groups, respectively. There was no case of non-union and radial nerve palsy in anteromedial plating cases whereas in anterolateral cases one patient did not achieve union and two (8.7%) had radial nerve injury, which recovered completely by the end of the study. An anterolateral approach with anteromedial surface plating on the flat medial aspect of the humerus is a good technique for fixing humeral fractures.

Postoperative Epidural Fibrosis Prevention: Which Is Better-Autologous Fat versus Gelfoam.

STUDY DESIGN: Prospective, randomized study of 100 patients with prolapsed intervertebral disc with an average of 12- to 18-month follow-up postoperatively. PURPOSE: To compare the role of Gelfoam and autologous fat in the prevention of postoperative epidural fibrosis (EF) after lumbar spine surgery. OVERVIEW OF LITERATURE: EF is a possible sequelae of lumbar disc surgery. Different treatments and surgical strategies have been attempted to prevent postoperative fibrosis without providing consistent long-term results. METHODS: The study was conducted on 100 adult patients. The patients were randomly allocated into two groups of 50 patients each: group A, autologous fat group, and group B, Gelfoam group. The postoperative follow-up was conducted at intervals of 6 weeks, 3 months, 6 months, and 12 months. Both groups were evaluated clinically (Oswestry Low Back Pain Disability Questionnaire [ODI], Visual Analog Scale [VAS], Straight Leg Raising Test [SLRT]) and radiologically (using Ross grading by contrast magnetic resonance imaging [MRI]) for development of radicular pain and hence EF. RESULTS: Based on the analysis, improvement in mean values of ODI score, VAS score, and SLRT were found to be statistically significant postoperatively at intervals of 6 weeks, 3 months, 6 months, and 12 months when compared individually in both groups. However, improvement was greater in the autologous fat group than in the Gelfoam group. Based on contrast-enhanced MRI, the number of patients who developed EF was smaller in the autologous fat group than in the Gelfoam group. CONCLUSIONS: In the present study, on clinical and radiological assessment, we conclude that both groups prevent radicular pain and postoperative EF individually but relatively autologous fat was found to be more effective than Gelfoam in the prevention of EF and hence radicular pain.

Clinical outcome in Giant cell tumor of cervico-thoracic spine: Our experience with three cases.

BACKGROUND: Giant cell tumor (GCT) of the spine is uncommon but most aggressive benign tumor of the spine with unpredictable outcome. The purpose of this study was to report on a surgical treatment for the cases of GCT (C2, T4 and C7-T1). The spine is not a common site for a Benign GCT, with a 2.5% incidence in the sacrum and 2.9% in the vertebrae above the sacrum. In the cervico-thoracic spine, the incidence is extremely low and has been reported very less in the literature. MATERIAL AND METHODS: This study was conducted on 3 cases of GCT of the spine and evaluated the outcome of different treatment modalities retrospectively. All the cases were treated with intralesional surgical resection but only one developed recurrence. RESULTS: Cord compression and neurological deficits of varying grades was observed in all the cases. All patients also presented with clinical as well as radiological instability. Overall results were satisfactory, as all patients were symptom-free postoperatively. One out of the three cases had tumour recurrence and needed repeat intervention. CONCLUSION: Giant cell tumour of cervico-thoracic spine is a rare entity and should be managed Surgically with en bloc/extralesional resection but due to risk of surrounding neurovascular structures damage they are managed by marginal resection therefore since total resection is not possible there are high chances of recurrences, Hence require close monitoring and follow up for early diagnosis and appropriate management.

Bilateral Monteggia Fracture: A Rare Case Presentation.

INTRODUCTION: Giovanni Monteggia was the first to describe two cases of fractures of the proximal third of ulna with dislocation of the radial head. Monteggia fractures much more commonly are seen in children than in adults, but the bilateral entity is rare in both age groups. The following case is about the course of treatment for bilateral Monteggia fractures in a young male. CASE REPORT: A 35-year-old male came to the emergency with alleged history of roadside accident. Radiography showed bilateral Monteggia fracture type III (by the Bados classification). Surgical intervention was required with locking compression plates put on the both sides. Closed reduction of the radial head was done on both sides. The patient was given pop slabs for bilateral forearms for 21 days. After removing the splints, the function of the elbow was determined by the Broberg Morrey score which was on the right side 45 and on the left side 47 and 100 on both sides after 5 months of follow-up. CONCLUSION: Surgical intervention and early rehabilitation are the most important and ideal line of treatment for the return of the good function of both elbows. Diagnosis, surgical technique, rehabilitation program, and clinical results are reported. The bilateral nature of the presentation does not affect the outcome of the fractures.

Objective measurement of shade color in age estimation.

INTRODUCTION: Age estimation is an important subspecialty of forensic medicine. Dental hard tissues are highly resistant to degradation and putrefaction. Enamel is translucent and varies in color from light yellow to grey white. The color of the teeth has been reported to be affected by chronological age. Enamel color may also depend on environmental factors viz. diet, occupational habits, vitamin deficiencies, fluoride level in drinking water etc., It has been found that color changes in dentin vary from white to yellow. Studies have been done to measure the dentin color for age estimation. AIM: To find a correlation between the enamel color and chronological age and secondly to estimate the age of an individual from enamel color. MATERIAL AND METHODS: A total of 300 patients visiting the outpatient department of oral medicine and radiology were selected. Out of those, 150 were men and 150 women. The patients were divided into V groups based on the age. A thorough case history was taken for all the patients. Maxillary Central and Lateral incisor was used for the estimation of shade. The enamel color was evaluated using a VITA classical shade guide. STATISTICAL ANALYSIS: Data were exported to an Excel spread sheet and statistical analysis was performed using the SPSS. Linear regression analysis was used to find correlations between age and enamel shade. RESULTS: In the group 1 and 2 i.e. from 15 to 36 years, the shades A 2 and B 2 (reddish hue) was found to be most common. While in the group 3 and 4, shades ranged from A 3 to B 3 (brownish to yellowish hue). In the patients above 59 years i.e. group 5 the enamel shade with greyish hue was found to be most common. CONCLUSION: Age determination using enamel color can be tried in forensic cases in the identification of individuals with no birth records.