Seasonal variation in orthopedic trauma patients-An experience from central India.

OBJECTIVES: This study aims to determine the various epidemiological factors responsible for orthopedic trauma cases: how do weather patterns, month, season and public working schedule influence the daily frequency of orthopedic trauma. MATERIAL AND METHODS: This was a descriptive study performed in the Department of Orthopedics at a tertiary care centre in central India Participants: 7980 trauma cases reported in our study period. Study variables: Demographic characteristics of the cases, time, day, the month of injury and type of trauma and cause of trauma. etc. Statistical analysis: Proportions. RESULTS: In our study period from 2005 to 2016, there were total 7980 admissions, the annual incidence of trauma was 22.78%. RTA was the commonest cause of injury (46.85%). Most common age group affected was 11-40 year age group (64.06%), with the predominance of Male (67.40%) and rural population (72%). The commonest victims of trauma were labourer (37.66%). Maximum cases of trauma occurred during summer (58.9%). Fracture of upper extremity especially around Elbow was common which were 987 (26.41%) amongst which the fracture supracondylar humerus in pediatric age group was most common around 456. And in rainy season and winter season, there was the dominance of lower extremity fracture which was fracture around Ankle and Foot (i.e 557; 23.59%) and fracture of tibia bone (i.e 516; 27.4%) respectively. CONCLUSION: Orthopedic trauma at a tertiary health care trauma center do vary significantly with the weather and are highest in the Summer season.

Early scaphoid fractures are better diagnosed with ultrasonography than X-rays: A prospective study over 114 patients.

PURPOSE: Wrist has a complex anatomy and undergoes complex injuries. Scaphoid fracture is one of such injuries. It is the most common fracture in carpal bone. Most of the scaphoid fractures are missed on initial X-rays. Magnetic resonance imaging (MRI) is considered as a gold standard for diagnosing scaphoid fractures. Ultrasonography (USG) is emerging as a good alternative to make an early diagnosis of scaphoid fractures. Our aim is to throw light upon the role of USG in detection of scaphoid fractures. METHODS: The study was centered upon 114 patients in the age range 10-65 years, with traumatic wrist injury and were clinically suspected to have scaphoid fractures. Patient with non-traumatic history, bilateral wrist injury and late presentation were excluded. X-rays, USG using high frequency probe and MRI were done for all patients. MRI was considered to be the gold standard test. Patients were followed up at 6 weeks. RESULTS: Of the 114 patients, X-ray could diagnose scaphoid fractures in 48 patients, 30 of which were confirmed by MRI. USG results were positive in 74 patients, of which MRI was positive in 67 patients. The accuracy of scaphoid fracture detection with USG was 98.04% in comparison to X-ray (20.58%), which was statistically significant. CONCLUSION: USG provides a more accurate and reliable method of making an early diagnosis of scaphoid fracture than X-rays. It is non-invasive, non-expensive and allows better visualisation of cortical disruption.

Evaluation of Outcome of Posterior Decompression and Instrumented Fusion in Lumbar and Lumbosacral Tuberculosis.

BACKGROUND: For surgical treatment of lumbar and lumbosacral tuberculosis, the anterior approach has been the most popular approach because it allows direct access to the infected tissue, thereby providing good decompression. However, anterior fixation is not strong, and graft failure and loss of correction are frequent complications. The posterior approach allows circumferential decompression of neural elements along with three-column fixation attained via pedicle screws by the same approach. The purpose of this study was to evaluate the outcome (functional, neurological, and radiological) in patients with lumbar and lumbosacral tuberculosis operated through the posterior approach. METHODS: Twenty-eight patients were diagnosed with tuberculosis of the lumbar and lumbosacral region from August 2012 to August 2013. Of these, 13 patients had progressive neurological deterioration or increasing back pain despite conservative measures and underwent posterior decompression and pedicle screw fixation with posterolateral fusion. Antitubercular therapy was given till signs of radiological healing were evident (9 to 16 months). Functional outcome (visual analogue scale [VAS] score for back pain), neurological recovery (Frankel grading), and radiological improvement were evaluated preoperatively, immediately postoperatively and 3 months, 6 months, and 1 year postoperatively. RESULTS: The mean VAS score for back pain improved from 7.89 (range, 9 to 7) preoperatively to 2.2 (range, 3 to 1) at 1-year follow-up. Frankel grading was grade B in 3, grade C in 7, and grade D in 3 patients preoperatively, which improved to grade D in 7 and grade E in 6 patients at the last follow-up. Radiological healing was evident in the form of reappearance of trabeculae formation, resolution of pus, fatty marrow replacement, and bony fusion in all patients. The mean correction of segmental kyphosis was 9.85° postoperatively. The mean loss of correction at final follow-up was 3.15°. CONCLUSIONS: Posterior decompression with instrumented fusion is a safe and effective approach for management of patients with lumbar and lumbosacral tuberculosis.