Journal of Orthopedic Education

 This short communication sought to perform an overview of research on efficacy of exercises in periarthritis shoulder/ adhesive capsulitis/ frozen shoulder. The included evidence demonstrated efficacy of exercises either individually (active range of motion exercises) or as comparison between types of exercise (scapulothoracic versus glenohumeral), comparison between exercises and other conservative treatments (supervised neglect, Maitland mobilization), exercises administered in combination (stretching and as a home exercise prescription an adjunct to other orthopaedic procedures such as hydroplasty, distension arthrography and manipulation under anesthesia. Although, limited evidence existed for its individual use, combination with other treatments might be suggested as a viable and cost-effective treatment option in orthopaedic rehabilitation of people with frozen shoulder.   

 Introduction: Intra-articular fracture of the distal humerusis a relatively rare injury &constitutes 0.5% to 0.7% of all fractures and 30% of elbow fractures. Traditionally these fractures have been managed operatively with various extensor mechanism disrupting approaches which are often associated with delayed/non union of the olecranon, triceps muscle weakness and osteotomy related implant prominence. Open Reduction and internal fixation of these fractures can be effectively accomplished through an ‘EXTENSOR MECHANISM on APPROACH.’We present a detailed description of surgical technique and management of Compound Intra- articular fracture distal end of humerus. Case Report: 25 year old male patient came to our Hospital following a fall from a height of 20 feet on his right elbow. Patient had a Compound Type III B injury (Gustillo Anderson Classification) with type C 2 distal humerus fracture. The fracture was initially managed with debridement, surgical toilet and external fixator application. This was followed with two weeks of regular wound care supplemented with parentral antibiotics. After the wound condition improved, definitive fixation of the intra-articular fracture was done with dual plating through an extensor mechanism on approach. Conclusion: Intra-articular fractures of distal humerus can be treated safely and successfully through extensor on approach which avoids extensor mechanism disruption and also avoids complications of olecranon osteotomy. This approach can be converted to conventional olecranon osteotomy if required intra-operatively. 

 Bone mineral density (BMD) and grip strength (GS) are two commonly employed clinical orthopedic examination procedures, where the former is laboratory-based and the latter clinically performed. The aim of this review article was to update the evidence for inter-relationship between BMD and GS through a preliminary search of PubMed.Of the total 11 studies, there were six population-specific studies on normal healthy population (adolescents, adults, men, women, older adults, older women), two studies on healthy athletes (young athletes, combat athletes), and three studies on postmenopausal women (Japanese, Thai, Turkish). Whilst the question of site-specific or systemic still remains unanswered, the answer was reported to be influenced by many other variables such as gender, body weight, hand dominance and menopausal status. Albeit, there is a positive association and strong correlation existing between grip strength and bone mineral density, with grip strength being an independent predictor of BMD in some population. There is need for controlled clinical trials on interventions aimed at improving grip strength and their effects on BMD in osteoporotic men and women.  

 Introduction: Present study was planned to know the benefits of laminectomy done under spinal anaesthesia compared with general anaesthesia. Study Design: During 2010 to 2015 seventy patients were operated for lumbar laminectomy, 40 cases under spinal anesthesia and 30 under general anesthesia. All were operated by posterior midline approach in prone position. All were disc prolapse at L3-L4 and L4-L5 level and spinal canal stenosis. All patients had backache with neurological symptoms in lower limb. Age group is 35 yrs. to 60 yrs. Males were 46 and 24 females. Preoperative clinical examination, MRI and X ray were done before selecting patients for surgery. Proper prior operative consent for operative intervention was obtained. Results: 1. Overall study revealed that L3-L4, L4-L5 and L5-S1 disc were commonly responsible for pain and neurological deficit.2. Cases operated under Spinal anesthesia for lumbar disc had better recovery, less bleeding, less complications and early ambulation was possible.3. General anesthesia has more complications and cardiorespiratory complications. Conclusion: Laminectomy done under spinal anesthesia has better outcome. Surgeon, anesthetist and patients have less problems intra and postoperative complications.  

 Background: Numerous variations of Intramedullary nails have been devised to achieve a stable fixation and early mobilization of subtrochanteric fracture, among which is the proximal femoral nail (PFN). We reported here the results of a prospective study carried out Institute on 30 consecutive patients who had suffered subtrochanteric fracture between from January 2013 – January 2015 and were subsequently treated with a PFN. Materials & Methods: The inclusion criteria being acute and/or pathological subtrochanteric femur fractures aged above 18 Years. The patients were maintained on traction preoperatively in cases whose surgical intervention was delayed for more than two days. All operations were performed under spinal/ epidural anesthesia. Postoperative mobilization was started once the patient’s conditions were favorable. Weight bearing was determined by the fracture pattern. Results: We came across 18 male patients and 12 female patients. 60% of the cases associated with RTA and 40% were associated with history of fall. The entire 30 patients with traumatic sub trochanteric fractures healed uneventfully except 2 cases of delayed union. No complication such as cut out or breakage of implant or peri implant fracture were encountered. Conclusions:  Long proximal femoral nail is the most reliable implant for sub trochanteric fractures, leading to high rate of union.The high advantages include minimal exposure, better stability and early mobilization with biological and biomechanical advantages.  

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 Clinical prediction rules (CPR) or clinical decision rules (CDR) facilitate clinical decision-making by utilizing a combination of presenting symptoms and signs in a person with orthopaedic disorder to predict his/her diagnosis, therapy responses and outcomes.This editorial presented the importance of CPR/CDRs in Evidencebased Orthopaedic clinical practice, and there is need to explore CPR/CDRs in disease-specific, procedurespecific and population-specific domains in the future.