Journal of Orthopedic Education

Background and Aim: There exists controversy on the treatment of displaced midshaft clavicle fractures. Such type of treatment included non operative as well as operative type. Hence forth the present study was performed with the aim to analyze the use of elastic, stable intra medullary titanium nails as a new invasive procedure. Materials & Methods: The totals of 40 cases with clavicle fracture were included in the study. The present study is randomized control trial. Out of 40 cases; 20 cases were treated conservatively and 20 cases were treated with intramedullary nailing. Follow up of the cases were taken in 4th, 8th, 12th week, 6th month and 12th month. Time taken for the union of the fracture was calculated radio graphically; functional outcome was measured utilizing Constant Murley Shoulder score. Result: At the end of the study when the comparison was done it was found that union of fracture by intra medullary nail group had less time as compared to conservative group. The difference was found to be statistically significant. Difference of functional outcome at regular interval follow up was also found to be significant. Conclusion: It is concluded that intra medullary nail treatment outcome is secure invasive surgical method with early union, quick return to routine work and lesser difficult faced.

Keywords: Clavicle; Conservative; Fracture; Intra Medullary Nailing.

Background: Morbidity and mortality rates are higher in individuals with rheumatoid arthritis than in the general population. Cardiovascular diseases now represent one of the most common causes of death in Rheumatoid arthritis. It appears to represent an independent risk factor for ischemic heart disease. Rheumatoid arthritis is characterized by inflammation of synovial membrane and oxidative stress has been implicated as mediators of tissue damage. Adenosine deaminase plays an important role in inflammation and uric acid, an endogenous antioxidant has free radical scavenging capacity. The aim of this study is to estimate the serum levels of ADA, MDA, uric acid and CRP levels to know the oxidative stress status in rheumatoid arthritis patients. Methods: This is a prospective case control study consists a total of 100 subjects of which 50 were RA patients and 50 were healthy controls. Serum ADA, MDA, uric acid levels and ESR were analyzed in both controls and cases. Statistical analysis was performed using independent‘t’ test. Results: Serum uric acid, ADA, MDA, CRP, ESR (p<0.0001) levels were found to be significantly high in rheumatoid arthritis patients when compared to controls. There is a strong positive correlation of biochemical parameters with disease activity score 28 (DAS28) in rheumatoid arthritis patients. Conclusion: In the present study increased serum uric acid, ADA, MDA, CRP levels and ESR clearly suggest their role in causing inflammation and increased oxidative stress in rheumatoid arthritis patients.

Keywords: Rheumatoid Arthritits; C - Reactive Protein; Uric Acid; Adenosine Deaminase; Oxidative Stress; Malondialdehyde; Erythrocyte Sedimentation Rate (ESR). 

Background and Aim: Tennis elbow also known as lateral epicondylitis is one of the frequent reasons for in the lateral side of elbow. When there is application of the local injection of autologous blood in case of tennis elbow, it provides humoral and cellular factors at the site of the lesion and provides a healing environment. Present study was done with the aim to evaluate the effects of the local corticosteroid injection and autologous blood injection in the management of the elbow. Materials & Methods: A randomized control study was performed on 40 patients; they were divided into two groups A & B with 20 patients in each group. Group A were given 2 ml of Autologous blood injection and group B were given 80 mg Steroid injection (methyl prednisolone). Follow up of the patient was done at regular intervals of 4 weeks, 12 weeks and 6 months. Results: After 4 weeks VAS pain score and Nirschl stage sustained to reduce in group A, but to the opposing in group B average VAS pain score raised from 1.68 to 1.88 and Nirschl stage too improved from 1.50 to 1.84 at 12 weeks & 6 months of follow up correspondingly. There was significant difference between the groups in VAS score (0.56 versus 1.88) and Nirschl stage (0.32 versus 1.84) at 6 months of follow up. At the six-month follow-up 90% patients had total pain release in group A in contrast to only 45% in group B. Seven out of 20 (35%) patients had reappearance of pain at 6 months of follow up in group B but none of patients reported reappearance of pain or disability in group A. Conclusion: Injection of autologous blood is a well-organized management modality for lateral epicondylitis, which is easy, not expensive, with fewer side-effects and smallest recurrence rate.

Keywords: Autologous; Lateral Epicondylitis; Steroid; Tennis Elbow. 

Background: Total joint arthroplasty are simple to relieve pain, to provide motion while maintaining stability and to correct deformity. Current total joint prosthesis which is properly implanted, consistently achieve excluding high success rates, in meeting these goals in both short term and long term follow up studies. The aim of this study is to analyze the functional outcome of fixed bearing total knee arthroplasty. To assess the functional outcome in patients undergoing total knee arthroplasty using knee society knee score system. Materials and Methods: This study was conducted in a tertiary care set up. This is a Prospective study conducted during the period of June 2009 – September 2014. Study includes 40 patients who underwent total knee Arthroplasty in 40 knees. Post traumatic arthritis patients were excluded from the study. Results and Discussion: In this study except two patients all others showed an improvement in knee score. Among those, 39 patients had excellent scores (85-100), 1 patients had good score (70-84). The mean increase in Knee score was 48.17. In our study we observed that the return to function is excellent to good at the follow up. All our patients showed an improvement in knee score except two. 19 patients had excellent scores (85-100), 1 patients had good score (70-84), 0 patients had fair results (60-69) and 0 had poor results. The mean increase in Knee score was 48.17. The function score was also improved from 19.75 in the preoperative period to 80.82 in the postoperative period. Conclusion: From this study it can be concluded that, the average postoperative range of movement improved to 101.89 degrees from the preoperative range of 92.7 degrees. The mean preoperative Knee society knee score was 36.03, while the mean postoperative score was 84.2 indicative of the overall good functional outcome.

Keywords: Arthritits; Tricompartmental Osteoarthritis; Knee Replacement; Knee Artholplasty; Knee Score; Joint Prosthesis; Rheumatoid Arthritis. 

Despite the advances in techniques and improvements in surgical implants, treatment of distal femoral fractures remains a challenge. Anatomical reduction of articular surface, stable internal fixation with minimal soft tissue stripping, restoration of limb alignment, early mobilization and ambulation are the pre requisite for good results. Though locking plates appear very promising in these fractures, long term studies are needed. Dynamic condylar screw (DCS) with 950 barrel plate is well established method of treating these fractures. Twenty adult patients who had supracondylar and intercondylar fractures of distal 15 cm of femur treated with DCS were studied, all the twenty fractures united with the average time to healing was 15.6 weeks in, ranging from 12 weeks to 18 weeks. In 5 cases some residual deformity, 3 cases deep infection, five patients had quadriceps lag of less than 100, three of them had ipsilateral lower limb associated fractures. Average knee flexion was 114°; range of flexion was from 1000 to 1250. Six patients in this series had mild pain in the knee. Overall functional results were excellent in 8 (40%) patients, good in 6 (30%) patients, moderate in 3 (15%) patients and poor in 3 (15%) patients. In none of the cases we had loss of fixation or implant failure. DCS augmented with interfragmentary lag screws gives good results in intra articular distal end fractures of femur. Judicious use of bone grafting can reduce the risk of non union in severely communited metaphyseal fractures.

Keywords: Distal Femur Fractures; Dynamic Condylar Screw (DCS).