Comparison of Efficacy between Transforaminal Epidural Steroid Injection Technique without Contrast versus with Contrast in Lumbar Radiculopathy: A Prospective Longitudinal Cohort Study.

STUDY DESIGN: A prospective longitudinal cohort study. PURPOSE: To evaluate the efficacy of two different techniques of transforaminal epidural steroid injection (TFESI) with contrast and without contrast in treating lumbar radiculopathy. OVERVIEW OF LITERATURE: Epidural injections are one of the most frequently used nonsurgical treatment options for managing lumbar radiculopathy. This study aims to simplify the TFESI technique, which is effective and requires less effort to replicate. METHODS: We collected data on 118 patients who underwent TFESI without contrast versus TFESI with contrast for lumbar radiculopathy. The pain was evaluated using a Numerical Rating Scale (NRS) for pain at 5 minutes, 2 hours, 2 weeks, and 2 months. The functional status was assessed using the Oswestry Disability Index (ODI) score. The operation time and fluoroscopic dosage were also measured using this score. RESULTS: Two groups of patients with radiculopathy were studied, comprising of 56 patients in the non-contrast group (NC group) and 62 patients in the contrast group (C group). There was a significant decrease in pain, as evaluated by NRS, in the C group compared to the NC group at 5 minutes post-procedure (3.39±1.54 vs. 3.86±0.72, with a p-value of 0.039). There was no significant difference in NRS scores at 2 hours, 2 weeks, and 2 months, as well as in ODI scores. The operation time and fluoroscopic dosage were lower in the group without contrast compared to the contrast group, with 12.58±3.30 minutes per level vs. 16.70±5.94 minutes per level (p <0.001) and 3.62±1.66 mGy vs. 5.32±2.74 mGy per level (p =0.014), respectively. No complications were reported in either group. CONCLUSIONS: There is no difference in pain and functional outcome when treating lumbar radiculopathy with or without contrast using TFESI. The TFESI without contract technique has a shorter operation time and lower intra-operative fluoroscopic dosage without complications.

The new intra-articular calcaneal fracture classification system in term of sustentacular fragment configurations and incorporation of posterior calcaneal facet fractures with fracture components of the calcaneal body.

OBJECTIVE: The aim of this study was to develop a new calcaneal fracture classification system which will consider sustentacular fragment configuration and relation of posterior calcaneal facet to calcaneal body. METHODS: The new classification system used sustentacular fragment configuration and relation of posterior calcaneal facet fracture with fracture components of calcaneal body as key aspects of main types and subtypes. Between 2000 and 2014, 126 intraarticular calcaneal fractures were classified according to the new classification system by using computed tomography images. The new classification system was studied in term of reliability, correlation to choices of treatment, implant fixation and quality of fracture reduction. RESULTS: Types of sustentacular fragment comprised type A, B and C. Type A sustentacular fragment included sustentacular tali containing middle calcaneal facet. In Type B and C fractures sustentacular fragment included medial aspect and entire posterior calcaneal facet as a single unit, respectively. The fractures with type A, B and C sustentacular fragments were classified as main type A, B and C intra-articular calcaneal fractures. The main type A and B comprised 4 subtypes. Subtypes A1, A3, B1, and B3 associated with avulsion and bending fragments of calcaneal body. Subtype A2, B2, and B4 associated with burst calcaneal body. Subtype B4 was not found in the study. Main type C had no subtype and associated with burst calcaneal body. The data showed good reliability. CONCLUSION: The study showed that our new intra-articular calcaneal fracture classification system correlates to choices of treatment, implant fixation and quality of fracture reduction. LEVEL OF EVIDENCE: Level IV, Study of Diagnostic Test.

Visual analogue scale foot and ankle: validity and reliability of Thai version of the new outcome score in subjective form.

BACKGROUND: Nowadays, measuring score in the form of subjective questionnaires is the important tool for clinical evaluation of the foot and ankle-related problems. VisualAnalogue Scale-Foot and Ankle (VAS-FA) is the newly developed subjective questionnaire, which has sufficiency of validity and reliability from a previous study OBJECTIVE: Translate the original English version of VAS-FA into the Thai version and evaluate the validity and reliability of Thai VAS-FA in patients with foot and ankle-related problems. MATERIAL AND METHOD: According to the forward-backward translation protocol, original VAS-FA was translated into the Thai version. Thai VAS-FA and validated Thai Short Form-36 (SF-36) questionnaires were distributed to 42 Thai patients to complete. For validation, Thai VAS-FA scores were correlated with SF-36 scores. For reliability, the test-retest reliability and internal consistency were analyzed. RESULTS: Thai VAS-FA score demonstrated the sufficient correlations with physical functioning (PF), role physical (RP), bodily pain (BP) domains, and total score of SF-36 (statistically significant with p < 0.001 level and r > 0.5 values). The result of reliability revealed highly intra-class correlation coefficient as 0.995 from test-retest study. The internal consistency was excellent with Cronbach alpha: 0.995. CONCLUSION: The original VAS-FA score is a well-validated, subjective, visual-analogue-scale based outcome score. The Thai version of VAS-FA form maintained the validity and reliability of the original version. This newly translated-validated score can be distributed for the evaluation of the functions, symptoms, and limitation of activities in Thai patients with foot and ankle problems.

[Major risk factors for the second contralateral hip fracture in the elderly].

OBJECTIVES: The purpose of this study was to determine which of the predisposing risk factors for the first hip fracture would continue to be effective for the development of the second hip fracture in the elderly. METHODS: Data of 125 patients (31 men, 94 women) aged 55 years or older were evaluated, who sustained first (group 1, n=97) and second contralateral (group 2, n=28) hip fracture. Patients who were treated with bisphosphonate, calcitonin, and estrogen were not included. RESULTS: The incidence of the second hip fracture was higher (78.6%) beyond 12 months of the first fracture. The risk for sustaining a second hip fracture was 3.96-fold greater in patients over 85 years of age (p<0.05). Among comorbid medical conditions, eye diseases (p=0.02) and neurological diseases (p=0.048) were significantly more frequent in group 2. There was an obvious relationship between the second hip fracture and lower Singh index grades of = or < 3 (p<0.001). Patients over 85 years of age and having a lower Singh index grade were found to have a 6.57-fold increased risk for developing a second hip fracture (95% CI: 2.13-20.3; p=0.001). In univariate analysis, neurological diseases represented a significantly increased risk. Eye diseases were highly associated with an increased risk for second hip fractures in univariate (OR: 3.3, 95% CI: 1.2-9.2, p=0.020) and multivariate (OR: 7.6, 95% CI: 1.9-30.7, p=0.004) analyses. The Singh index of grade = or < 3 showed the highest associations with second hip fractures in both univariate (OR: 18.9, 95% CI: 5.8-65.9, p<0.001) and multivariate (OR: 30.00, 95% CI: 7.9-112.9, p<0.001) analyses. CONCLUSION: We concluded that, of all the risk factors for the first hip fractures, only hypotrophic changes in the proximal femoral trabeculae, eye diseases, and neurological diseases acted as major risk factors for the second contralateral hip fractures in the elderly.

Minimally invasive open wedge high tibial osteotomy with press-fit tricortical bone graft.

BACKGROUND: Numerous operative procedures has been described for high tibial osteotomy (HTO), however the HTO without implant fixation has never been reported. OBJECTIVE: The objective of this study was to propose a new technique and evaluate the preliminary results. MATERIAL AND METHOD: Prospective review study on a series of case, at the Hospital. Seventeen patients (10 females, 7 males), and a total of 18 knees with a mean age at the operative time of 53 years (range, 35 to 64 years) were available for follow-up evaluation at a minimum of 24 months. The open-wedge HTO with press-fit tricortical bone graft was performed by one surgeon. RESULTS: The average time to union was 8.5 weeks (range, 6 to 12). There was one case of delayed union (5.5%). No nonunion, grafts collapse or dislodge were found. The average preoperative varus deformity was 8 degrees (range 6 to 11) and postoperative valgus was 8 degrees (range, 6 to 13). The pre and postoperative average pain level were 8.7 (range, 7 to 10) and 3.6 (range, 0 to 7), respectively. The average satisfaction score of the patients was 77% (range 50-100%). The average Knee Society Score was 82.3 +/- 6.4. CONCLUSION: Considering its less morbidity, excellent cosmesis, no need for second operation to remove the implant, excellent cost effectiveness and no complications from internal fixation, this new technique offers an attractive alternative in HTO.

An estimation of grip strength during puberty.

OBJECTIVE: Find the correlation of grip strength in puberty with chronological age, height, weight, and percentage of body fat. MATERIAL AND METHOD: One thousand one hundred and five volunteer students between 11 and 14 years of age in Central Thailand participated in the study. The body weight and height were measured with standard balance and stadiometer The percentage of body fat was measured with Near Infrared interactance device. The grip strength was measured with Digital Handgrip Dynamometer The results were statistically analyzed by multiple linear regression. RESULTS: It was found that grip strength has a significant correlation with age, height, and weight but not with percentage of body fat. The prediction of grip strength in puberty can be estimated with the following equations: a) For boys, Grip strength (kg) = -59.797 + 2.493 Age (yr) + 0.308 Height (cm) + 0.147 Weight (kg), and b) For girls, Grip strength (kg) = -32.887 + 0.926 Age (yr) + 0.236 Height (cm) + 0.155 Weight (kg). CONCLUSION: The predictive value of an age, height, and weight equation is more precise than that of solely chronological age.