Effect of pedicle screw placement into the fractured vertebra in management of unstable thoracolumbar and lumbar fractures.

BACKGROUND: Pedicle screw insertion at the level of the fractured vertebra has been shown to improve clinical and radiological outcomes in unstable thoracolumbar and lumbar fractures, albeit this requires further evidence. The study aims to evaluate the effect of pedicle screw placement on the fractured vertebra in such cases. METHODS: A prospective study included adult patients with thoracolumbar and lumbar fractures treated with short-segment posterior instrumentation with a pedicle screw into the fractured vertebra. Anterior vertebral body height loss, kyphotic angle and degree of spinal canal compromise were measured preoperatively and postoperatively in radiographs and CT scans. The neurological status was followed up for one year of the postoperative period. RESULTS: The study included a total of 30 patients. Five patients (16.7%) had grade C, three patients (10%) had grade D, and 22 patients (73.3%) had grade E neurological status. The mean (SD) preoperative kyphotic angle, vertebral body height and canal compromise were 5.54 (5.35), 39.67% (8.04), and 31.59% (10.62), respectively. Postoperatively there was a significant canal decompression, with a mean postoperative spinal canal compromise of 5.53% (SD=7.70; p-value <0.001). At the end of one year of follow-up, the radiological evaluation showed a correction of the kyphotic angle to 6.62 (SD=2.57; p-value <0.001), and the mean anterior vertebral body height was 70.38% (SD=11.25; p-value <0.001). At the end of one year, there was a significant overall neurological recovery with a final neurological status of grade D in 5 (16.7%) and grade E in 25 patients (83.3%). There was no significant association between canal decompression and neurology at the end of the one-year follow-up. CONCLUSION: Unstable thoracolumbar and lumbar fractures surgically treated with short-segment fixation with an additional intermediate screw can achieve significant restoration of vertebral body height and correction of kyphotic angle without any added complications.

Comparison of radiological and functional outcome of unstable intertrochanteric femur fractures treated using PFN and PFNA-2 in patients with osteoporosis.

INTRODUCTION: Presently, unstable intertrochanteric femur fractures are treated commonly with intramedullary nailing devices. Various designs of intramedullary nail are introduced. The conventional Proximal Femoral Nail has given diverse outcome. Complications have also been noted with this implant. Newer designs like Proximal Femoral Nail Antirotation-2 have been introduced for Asian population. The aim of our study was to compare the radiological and functional outcome of unstable intertrochanteric femur fracture treated with conventional Proximal Femoral Nail and Proximal Femoral Nail Antirotation-2 in osteoporotic patients. MATERIALS AND METHODS: Patients presenting with unstable intertrochanteric femur fracture (AO classification) and Singh's index ≤ 3 were included. Patients were assigned to the groups based on the implant used for treatment (PFN and PFNA2 group). Post-operative radiographs were used to assess the quality of reduction, by calculating neck shaft angle. The quality of fixation was assessed, by calculating tip apex distance and Cleveland index. The duration of surgery, blood loss, number of fluoroscopic images taken and length of hospital stay were noted. Patients were followed up for 6 months, and complications were noted. The functional outcome was compared using modified Harris hip score. The data analysis was done using Student's unpaired t test/Mann-Whitney U test and Chi-square test/Fisher's exact test. A p value less than 0.05 was considered significant. RESULTS: Seventy-eight patients with unstable intertrochanteric fractures and Singh's index < 3 were included. Thirty-seven were treated with PFNA2 and 41 with PFN. The average age in PFNA2 group was 69.51, and PFN group was 70.804. Nine patients in PFNA2 group and 10 patients in PFN group had tip apex distance more than 25 mm. Twelve patients in PFNA2 group and 14 Patients in PFN group had sub-optimal implant position as per Cleveland index. The difference in neck shaft angle between uninjured and operated side was more than 10° in four patients of PFNA2 group and seven patients of PFN group. The average Harris hip score was 74.55 for PFNA2 group and 69.88 for PFN group. Four complications were seen in PFNA2 group and 5 in PFN group. CONCLUSION: The functional outcome (p = 0.102) achieved with both the implants was similar. Good functional outcome can be achieved, when the radiological parameters are restored, i.e. TAD < 25 mm, Cleveland index in centre-centre position and neck shaft angle difference < 5°. The overall complications, in the set-up of osteoporosis, seen with both the implants were similar (p = 0.44). PFNA2 group showed better results in terms of perioperative morbidity.

A Case Report of Isolated Cysticercosis of Biceps Muscle.

INTRODUCTION: Cysticercosis is more commonly seen in developing countries like India caused by larval stage of Taenia solium. Neurocysticercosis is more commonly seen than isolated muscle involvement. There are very few sporadic cases of isolated biceps muscle involvement, but most of them are managed medically. We are reporting an isolated case of cysticercosis of biceps muscle managed surgically. CASE REPORT: A 32-year-old male, security personnel by occupation, comes with complaints of painful swelling of the right arm for past 1 week. There was no trauma to the limb and no similar swellings elsewhere in the body. On examination, there was an anteromedial tender swelling of mid-third of arm. X-ray was normal with soft tissue shadow on the anterior aspect. Ultrasound showed cystic lesion with central hyperechoic lesion. Magnetic resonance imaging of arm showed 7.7 mm × 4.8 mm lesion in anteromedial aspect of arm with surrounding edema s/o granuloma. The patient underwent excision of the cyst and biopsy was suggestive of cysticercosis and surrounding granuloma. CONCLUSION: Isolated cysticercosis of muscle is very rare, but when it is symptomatic and hindering in daily activities, surgical excision can be done for faster relief and early return to normal day-to-day activities.