Journal of Orthopedic Education

Spondylodiscitis is an infection of the spine that involves the intervertebral disc and the vertebral body characterized by insidious onset and nonspecififc symptoms. The clinical examination, neurological status at the time of presentation and strong suspicion are major factors in the treatment decision making and patient outcome. Early diagnosis has a crucial role in the management of the disease and inclines the morbidity rates. We present a case of 53-yearold female who presented with back pain and diagnosed to have spondylodiscitis. The diagnostic work-up included blood investigations, MRI, CT guided biopsy and culture.

Keywords: Spondylodiscitis, back pain, management, diagnosis.

Distal radius fracture constitute about 10% of total skeletal trauma involving both elderly and young patients and can be both extrarticular and intrarticular and has been treated with various modalities. Conservative mode of treatment has been in practice since time immemorial. However with enhanced anatomical learning and advent of increased operative procedures and implants, distal end of radius involving articular surface have increasingly being operated (atin). There are many shortcomings such as prolonged immobilisation, malunion, pin tract infection, which may result in fixed range of movements therefore this study was done to different types of wrist fracture and their management with open reduction and internal fixation with volar plating and its relative complication. OA classification has been considered in this study and post operative progress was determined with help of modified Gartland and Werley’s wrist grading system. (shushrut)

Keywords: Distal radius fracture; Volar plating.

Introduction: Thoracolumbar burst fractures, frequently associated with kyphotic deformity and neurological deficit are very common in younger patients and could have a great impact on their daily physical activities. The primary goal of treatment of the thoracolumbar fracture is keeping patients alive, protecting from the further neural damage, obtaining the stability by reconstructing anatomical alignment of spinal columns and returning patients to workplace through early mobilization and rehabilitation. Aim: Comparison between two groups which includes short segment fixation (fracture vertebrae and long segment fixation with pedicle screw). Material and Methods: This Hospital based Prospective Randomized comparative interventional study between two groups in Department of Orthopaedics SMS Medical College and hospital Jaipur from Nov 2016 to Oct 2018. It included 25 cases of acute, traumatic fractures of the thoracolumbar junction (T9- L3) treated with short segment pedicle fixation one level above and one level below the fractured vertebra including at least one pedicle screw in fractured vertebrae and 25 cases are treated with long segment pedicle screw fixation included the instrumentation at least of two vertebrae above and two vertebrae below the fracture. Complete clinical and neurological examination was done. Observations and Results: The surgical management of thoracolumbar burst fractures through posterior approach, the short segment pedicle screws fixation was not significantly different to the long segment pedicle screws fixation in terms of correction of kyphotic deformity improvement of back pain and return to work and also in LS instrumentation prolonged the operative time and increased the amount of blood loss significantly. SFIFL offers significant advantages such as incorporating fewer motion segments in the fusion, shorter operative time and maintenance of the correct sagittal alignment. Partial neurologic deficits have potential for recovery, the amount depending more on the initial deficit and the time elapsed since the initial deficit than the treatment strategy. Serious complications are rare. Conclusion: Short-segment instrumentation using additional screws at the fracture level in thoracolumbar burst fractures is a proper surgical approach for obtaining clinically and radiologically successful results in terms of the kyphosis angle in a maintenance of the sagittal alignment this technique allowed to save two or more segments of vertebral motion, operative time and blood loss as compared to long segment fixation.

Keywords: Thoracolumbar burst fractures; Kyphosis angle, Short segment pedicle screw fixation.

Introduction: Dynamic hip screw was commonly recommended and practiced as a choice of treatment for Intertrochanteric fracture recently the trends have changed towards intramedullary nailing along with sliding screw. Internal fixation is appropriate choice for intertrochanteric fracture; optimal fixation is based on stability of fracture. A new method for intertrochanteric fractures treatment involves the use of an intramedullary nail that interlocks proximally into the femoral head was in traduced in early 1990s. Methods: Study will be prospective, time bound, hospital based, randomized comparative study. Cases satisfying the inclusion criteria admitted in AMC during the study period of October 2016 to October 2018 will be included. Results: Total of 50 patients were treated for unstable intertrochanteric fracture among which 25 were treated with intramedullary nail (TFN, PFN) and 25 patients with extramedullary fixation (Dhs), among which intramedullary fixations showed better results in terms of functional outcome and clinical outcome compared to extramedullary group. in terms of duration of surgery, blood loss intramedullary group were better compared to extramedullary group. In terms of complete union of fracture and functional out come using Harris hip score at 1month and 6 month results were similar in both groups. But intramedullary group had 19 of excellent outcome, 6 of good, 0 fair and extramedullary 10 excellent 11 good and 4 fair results, and one case of Dhs had complication of screw cut out. Conclusion: Taking all parameter into consideration intramedullary nail is preferred choice of treatment for unstable intertrochanteric fracture because of bio mechanical advantage.

Keywords: Unstable intertrochanteric fracture; Extramedullary, Intramedullary; Harris hip score.