Objectives The femoral shaft fractures constitute 1.6% of the pediatric fractures. Intramedullary nailing is a common mode of fixation in older children and adolescents. The rigid intramedullary locking nail is a preferred choice over flexible nails in overweight patients and children older than 11 years of age. The adolescent age group with skeletal immaturity deserves special attention from the surgeons because of grave complications like avascular necrosis of the femur head and angular deformities. The aim of this study is to report the outcome of an adolescent femur shaft fracture treated with a rigid intramedullary interlocking nail in North Indian patients. Materials and Methods This is a retrospective analysis performed by retrieving records of 19 patients. Patients with open fractures, polytrauma and neurovascular injuries were excluded. The preoperative and post-operative radiographic orthogonal views were analyzed to assess parameters like alignment, union and avascular necrosis (AVN). Results The mean age was 12.3 years. The mean follow-up was 1.5 years. The average time for union was 8 weeks. All the fractures were united in an acceptable alignment and rotation. There was no avascular necrosis, angular deformity and infection. The mean femur length discrepancy was 7 mm. Conclusion The rigid intramedullary interlocking nail is a valuable option for the fixation of femoral shaft fractures in an adolescent age group with a good union rate and minimal complications.
{"title":"Results of the Pediatric Shaft Femur Fracture Treated with Closed Rigid Lateral Trochanteric Entry Intramedullary Nail in North Indian Population","authors":"Rajeev Kansay, Saurabh Vashisht, Siddharth Kothari, Ashwani Soni, Rohit Jindal, Sudhir Garg","doi":"10.25259/ijrsms_1_2023","DOIUrl":"https://doi.org/10.25259/ijrsms_1_2023","url":null,"abstract":"Objectives The femoral shaft fractures constitute 1.6% of the pediatric fractures. Intramedullary nailing is a common mode of fixation in older children and adolescents. The rigid intramedullary locking nail is a preferred choice over flexible nails in overweight patients and children older than 11 years of age. The adolescent age group with skeletal immaturity deserves special attention from the surgeons because of grave complications like avascular necrosis of the femur head and angular deformities. The aim of this study is to report the outcome of an adolescent femur shaft fracture treated with a rigid intramedullary interlocking nail in North Indian patients. Materials and Methods This is a retrospective analysis performed by retrieving records of 19 patients. Patients with open fractures, polytrauma and neurovascular injuries were excluded. The preoperative and post-operative radiographic orthogonal views were analyzed to assess parameters like alignment, union and avascular necrosis (AVN). Results The mean age was 12.3 years. The mean follow-up was 1.5 years. The average time for union was 8 weeks. All the fractures were united in an acceptable alignment and rotation. There was no avascular necrosis, angular deformity and infection. The mean femur length discrepancy was 7 mm. Conclusion The rigid intramedullary interlocking nail is a valuable option for the fixation of femoral shaft fractures in an adolescent age group with a good union rate and minimal complications.","PeriodicalId":499227,"journal":{"name":"International journal of recent surgical and medical science","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135858192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To shed light on the dangers of alprazolam overuse and misuse among Indians, this review analyzed a large number of studies done so far. In this article, we reviewed the likelihood of alprazolam (benzodiazepine – a commonly used medication for panic and anxiety disorders) being among the most commonly abused substances in India in the near future. The review takes into account pharmacological features, addiction neuroscience, epidemiological statistics, sociocultural aspects, availability and effects. It emphasizes the necessity of developing specialized preventive plans, raising awareness and putting in place strong regulatory measures to deal with the new problem of alprazolam addiction and usage in India.
{"title":"Is Alprazolam A Potential Drug of Abuse In India’s Near Future?","authors":"Kaushik Rao Juvvadi, Jonnalagadda Vihari, Brijeshraj Swain, Samir Sahu, Nalinikanta Sahoo, Meghanad Meher, Annamdevula Vamsi Krishna, Sourav Maiti, Sadab Islam","doi":"10.25259/ijrsms_19_2023","DOIUrl":"https://doi.org/10.25259/ijrsms_19_2023","url":null,"abstract":"To shed light on the dangers of alprazolam overuse and misuse among Indians, this review analyzed a large number of studies done so far. In this article, we reviewed the likelihood of alprazolam (benzodiazepine – a commonly used medication for panic and anxiety disorders) being among the most commonly abused substances in India in the near future. The review takes into account pharmacological features, addiction neuroscience, epidemiological statistics, sociocultural aspects, availability and effects. It emphasizes the necessity of developing specialized preventive plans, raising awareness and putting in place strong regulatory measures to deal with the new problem of alprazolam addiction and usage in India.","PeriodicalId":499227,"journal":{"name":"International journal of recent surgical and medical science","volume":"62 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135350874","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-27DOI: 10.25259/ijrsms-2022-4-20
Jaimin D Shah, Tapan A Shah, Jatinkumar B Modi
Objectives The abdomen is a diagnostic black box. Physical examination of the abdomen is unreliable in making this determination, and sometimes clinical evaluation is difficult due to the influence of drugs or alcohol by patients or abdominal injuries occurring with head or spinal cord injuries. However, the presence of abdominal rigidity or hemodynamic compromise is an indication for prompt surgical exploration. For the remainder of patients, a variety of diagnostic adjuncts are used to identify abdominal injury. In this study, our aim is to find the answer of these questions, (1) What was the major indication for operation in each case? (2) Did delays in getting the patient to the operating room affect the outcome? (3) How to find morbidity and mortality in blunt abdominal injuries, at the behest of the Blunt Abdominal Trauma Severity Scoring System (BATSS). Materials and Methods A retrospective study of 100 cases of blunt abdominal trauma was done at Sheth Lallubhai Gordhandas Municipal General Hospital, Narendra Modi Medical College, Ahmedabad, for the accuracy of the BATSS score. Patients were divided into three groups according to the BATSS: (1) ≥12 score group, (2) 8–11 score group, and (3) <8 score group. Results Operative management was more common in the high-risk group, while the low-risk group was managed conservatively under expert guidance. The mean BATSS scores in operative and conservative management were 14.77 ± 2.91 and 5.12 ± 2.56, respectively. The BATSS score had an 87.1% Specificity, 100% Sensitivity, 94.5% Negative predict value (NPV), 100% Positive predict value (PPV) and an overall Accuracy of 96%. Conclusion BATSS is important for triage and is an excellent tool for recognising and picking up high-risk patients with blunt abdominal injuries.
{"title":"Blunt Abdominal Trauma Severity Scoring System: Exceptional score in Blunt Abdominal Trauma Management","authors":"Jaimin D Shah, Tapan A Shah, Jatinkumar B Modi","doi":"10.25259/ijrsms-2022-4-20","DOIUrl":"https://doi.org/10.25259/ijrsms-2022-4-20","url":null,"abstract":"Objectives The abdomen is a diagnostic black box. Physical examination of the abdomen is unreliable in making this determination, and sometimes clinical evaluation is difficult due to the influence of drugs or alcohol by patients or abdominal injuries occurring with head or spinal cord injuries. However, the presence of abdominal rigidity or hemodynamic compromise is an indication for prompt surgical exploration. For the remainder of patients, a variety of diagnostic adjuncts are used to identify abdominal injury. In this study, our aim is to find the answer of these questions, (1) What was the major indication for operation in each case? (2) Did delays in getting the patient to the operating room affect the outcome? (3) How to find morbidity and mortality in blunt abdominal injuries, at the behest of the Blunt Abdominal Trauma Severity Scoring System (BATSS). Materials and Methods A retrospective study of 100 cases of blunt abdominal trauma was done at Sheth Lallubhai Gordhandas Municipal General Hospital, Narendra Modi Medical College, Ahmedabad, for the accuracy of the BATSS score. Patients were divided into three groups according to the BATSS: (1) ≥12 score group, (2) 8–11 score group, and (3) <8 score group. Results Operative management was more common in the high-risk group, while the low-risk group was managed conservatively under expert guidance. The mean BATSS scores in operative and conservative management were 14.77 ± 2.91 and 5.12 ± 2.56, respectively. The BATSS score had an 87.1% Specificity, 100% Sensitivity, 94.5% Negative predict value (NPV), 100% Positive predict value (PPV) and an overall Accuracy of 96%. Conclusion BATSS is important for triage and is an excellent tool for recognising and picking up high-risk patients with blunt abdominal injuries.","PeriodicalId":499227,"journal":{"name":"International journal of recent surgical and medical science","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135477617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives To assess various parameters of outcomes in the management of keloid by comparing the combination of 5-Fluorouracil (5-FU) with triamcinolone acetate and triamcinolone alone. Materials and Methods The present study was carried out as a prospective comparative study over a period of 24 months. A total of 70 diagnosed Keloids patients were included in the study, who were randomly divided into two equal groups: 35 patients were administered triamcinolone acetate and 5-FU (0.1 mL TA + 0.9 mL 5-FU) were classified as Group A (Triamcinolone acetonide [TAC] + 5-FU) while the remaining 35 (50.0%) patients were administered a 1 mL intralesional injection of triamcinolone acetate alone and were classified as Group B (TAC alone). Patients of both groups were administered the injections selected for them at a 3 week interval for 3–6 months. Patients and independent observers assessed the scar at each visit until the last follow-up. Assessment by patients was done for pain, itching, scar colour, stiffness, thickness and irregularity of the keloid on a 10-point scale, with higher values showing worse results. Assessment of scars by an independent observer was done on a similar scale, including vascularization, pigmentation, thickness and pliability. Results Initially vascularity, scar colour, vascularity and thickness of patients’ scars in both the groups assessed by the patient as well as the observer were comparable, which remained comparable up to the administration of the second dose. Thereafter, both patient and observer observed that the parameters of TAC + 5-FU administered patients were significantly lower than of those administered TAC alone. Assessment of irregularity in shape and pliability of scar was done only by the patient. Initially both irregularity and pliability of the patients in both groups were comparable, which remained comparable up to the administration of the third dose. Thereafter, the parameters of TAC + 5-FU administered patients were significantly lower than those administered TAC alone. Conclusion The findings in this study indicate that adjuvant 5-FU to TAC was more effective as compared to TAC alone.
目的比较5-氟尿嘧啶(5-FU)联合醋酸曲安奈德与单用曲安奈德治疗瘢痕疙瘩的疗效。材料与方法本研究是一项为期24个月的前瞻性比较研究。本研究共纳入70例确诊瘢痕瘤患者，随机分为两组:35例患者给予醋酸曲安奈德+ 5-FU (0.1 mL TA + 0.9 mL 5-FU)，分为A组(曲安奈德[TAC] + 5-FU)，其余35例(50.0%)患者单独给予1 mL病灶内注射醋酸曲安奈德，分为B组(TAC单独)。两组患者每隔3周注射1次，疗程3 ~ 6个月。患者和独立观察员在每次访问时评估疤痕，直到最后一次随访。患者对瘢痕疙瘩的疼痛、瘙痒、疤痕颜色、僵硬度、厚度和不规则性进行10分制评估，数值越高结果越差。由独立观察员对疤痕进行类似的评估，包括血管化、色素沉着、厚度和柔韧性。结果最初，两组患者和观察者评估的血管密度、疤痕颜色、血管密度和疤痕厚度具有可比性，直到第二次给药时仍然具有可比性。此后，患者和观察员均观察到，TAC + 5-FU组患者的各项参数明显低于单独使用TAC的患者。疤痕形状和柔韧性的不规则性评估仅由患者完成。最初，两组患者的不规则性和柔韧性具有可比性，直到第三次给药时仍然具有可比性。此后，TAC + 5-FU组患者各项指标明显低于单独使用TAC组。结论5-FU辅助TAC治疗比单独使用TAC治疗更有效。
{"title":"Comparative Study of Combination of Intralesional Triamcinolone Acetate with 5-Fluorouracil Versus Triamcinolone Alone in Treatment of Keloid","authors":"Sudeep Kumar, Pankaj Kumar, Shadab Asif, Sandhya Pandey","doi":"10.25259/ijrsms-2022-2-16","DOIUrl":"https://doi.org/10.25259/ijrsms-2022-2-16","url":null,"abstract":"Objectives To assess various parameters of outcomes in the management of keloid by comparing the combination of 5-Fluorouracil (5-FU) with triamcinolone acetate and triamcinolone alone. Materials and Methods The present study was carried out as a prospective comparative study over a period of 24 months. A total of 70 diagnosed Keloids patients were included in the study, who were randomly divided into two equal groups: 35 patients were administered triamcinolone acetate and 5-FU (0.1 mL TA + 0.9 mL 5-FU) were classified as Group A (Triamcinolone acetonide [TAC] + 5-FU) while the remaining 35 (50.0%) patients were administered a 1 mL intralesional injection of triamcinolone acetate alone and were classified as Group B (TAC alone). Patients of both groups were administered the injections selected for them at a 3 week interval for 3–6 months. Patients and independent observers assessed the scar at each visit until the last follow-up. Assessment by patients was done for pain, itching, scar colour, stiffness, thickness and irregularity of the keloid on a 10-point scale, with higher values showing worse results. Assessment of scars by an independent observer was done on a similar scale, including vascularization, pigmentation, thickness and pliability. Results Initially vascularity, scar colour, vascularity and thickness of patients’ scars in both the groups assessed by the patient as well as the observer were comparable, which remained comparable up to the administration of the second dose. Thereafter, both patient and observer observed that the parameters of TAC + 5-FU administered patients were significantly lower than of those administered TAC alone. Assessment of irregularity in shape and pliability of scar was done only by the patient. Initially both irregularity and pliability of the patients in both groups were comparable, which remained comparable up to the administration of the third dose. Thereafter, the parameters of TAC + 5-FU administered patients were significantly lower than those administered TAC alone. Conclusion The findings in this study indicate that adjuvant 5-FU to TAC was more effective as compared to TAC alone.","PeriodicalId":499227,"journal":{"name":"International journal of recent surgical and medical science","volume":"38 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135477070","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-27DOI: 10.25259/ijrsms-2022-8-1
Rajalaxmi Satapathy, Pitamber Behuria
A 58-year female presented with behavioral changes, dementia, and hallucinations for which she was initially treated as a case of schizophrenia. Later she developed hypersomnolence, speech difficulty and urinary incontinence. She also developed seizures later. On investigations cerebrospinal fluid (CSF) cell count was high and chest x-ray revealed homogeneous opacity over the left upper and midzone. Contrast-enhanced computerized tomography (CECT) Thorax revealed apical segment collapse consolidation with air bronchogram and bilateral pleural effusion. Multiple hepatic and bony metastasis s/o primary bronchoalveolar carcinoma. Osteolytic lesions were also found on skull x-ray and on pelvis x-ray. Tissue diagnosis couldn’t be done as the patient’s general condition deteriorated and the patient left against medical advice. From the above clinical picture and investigation findings, it was diagnosed as a case of paraneoplastic limbic encephalitis.
{"title":"A Journey from Schizophrenia to Paraneoplastic Limbic Encephalitis","authors":"Rajalaxmi Satapathy, Pitamber Behuria","doi":"10.25259/ijrsms-2022-8-1","DOIUrl":"https://doi.org/10.25259/ijrsms-2022-8-1","url":null,"abstract":"A 58-year female presented with behavioral changes, dementia, and hallucinations for which she was initially treated as a case of schizophrenia. Later she developed hypersomnolence, speech difficulty and urinary incontinence. She also developed seizures later. On investigations cerebrospinal fluid (CSF) cell count was high and chest x-ray revealed homogeneous opacity over the left upper and midzone. Contrast-enhanced computerized tomography (CECT) Thorax revealed apical segment collapse consolidation with air bronchogram and bilateral pleural effusion. Multiple hepatic and bony metastasis s/o primary bronchoalveolar carcinoma. Osteolytic lesions were also found on skull x-ray and on pelvis x-ray. Tissue diagnosis couldn’t be done as the patient’s general condition deteriorated and the patient left against medical advice. From the above clinical picture and investigation findings, it was diagnosed as a case of paraneoplastic limbic encephalitis.","PeriodicalId":499227,"journal":{"name":"International journal of recent surgical and medical science","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135477074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-27DOI: 10.25259/ijrsms-2022-12-2
James Thiek, Devajyoti Sharma, Akash Guha, Lachit Kalita
Background Patients undergoing modified radical mastectomy (MRM)/breast-conserving surgery (BCS) with axillary nodal clearance experience significant post-operative pain, resulting in immobilization and increased usage of analgesics. These factors in turn result in delayed discharge. The pecs 1 and pecs 2 blocks have proven to be of significant benefit in relieving post-operative pain in such patients. [1–7] Objectives A case series was performed at our institute to note the effects of pecs 1 and pecs 2 blocks on post-operative opioid use, early mobilization of the upper limbs, decreased incidence of early post-operative limb swelling and enhanced recovery after surgery. Material and Methods We included six patients who underwent BCS with axillary lymph node dissection/MRM wherein intraoperative pecs 1 and pecs 2 blocks were used. Patients were given pecs 1 and 2 blocks with 10+20 mL 0.25% injection of bupivacaine under ultrasound guidance after induction. Only patients who were American society of anesthesiologists (ASA) class [8] 1 and 2 pre-operatively were included in the study. Results In our study, opioids were completely avoided and it was seen that post-operative pain was adequately controlled with single doses of non-steroidal anti-inflammatory drugs if patients received intra-operative pecs 1 and 2 blocks. The pain control was rather sustained and adequate for the institution of early post-operative physiotherapy and thus early discharge and enhancing recovery after surgery. Conclusion Post-operative analgesia provided by pecs 1 and 2 blocks resulted in adequate and sustained pain control for early institution of upper limb physiotherapy and mobilization of patients after MRM/BCS with axillary lymph node dissection, which subsequently results in decreased incidence of early post-operative oedema of limb on operated side and early recovery after surgery.
背景:接受改良根治性乳房切除术(MRM)/保乳手术(BCS)并清除腋窝淋巴结的患者会经历明显的术后疼痛，导致固定和增加止痛药的使用。这些因素反过来又导致延迟放电。1号和2号胸肌阻滞已被证明对缓解此类患者的术后疼痛有显著的益处。[1 - 7]目的通过本研究所的一系列病例研究，观察第1和第2胸肌阻滞对术后阿片类药物使用、上肢早期活动、术后早期肢体肿胀发生率降低和术后恢复的影响。材料和方法我们纳入了6例接受BCS并腋窝淋巴结清扫/磁共振成像的患者，术中使用了胸1和胸2块。诱导后在超声引导下给予胸1、胸2块10+20 mL 0.25%布比卡因注射。仅纳入术前美国麻醉医师学会(ASA)[8] 1级和2级的患者。结果在我们的研究中，完全避免了阿片类药物，并且发现如果患者术中接受1和2块阻滞，单剂量非甾体类抗炎药可以充分控制术后疼痛。疼痛的控制是相当持久的和足够的机构早期术后物理治疗，从而早日出院和促进术后恢复。结论1号和2号胸肌阻滞提供的术后镇痛，为MRM/BCS术后早期上肢物理治疗和腋窝淋巴结清扫患者活动提供了充分和持续的疼痛控制，从而降低了术后早期手术侧肢体水肿的发生率和术后早期恢复。
{"title":"Post-Operative Analgesia and Enhanced Recovery after Pecs 1 and Pecs 2 Blocks in Patients Undergoing Modified Radical Mastectomy/Breast-Conserving Surgery with Axillary Lymph Nodal Clearance","authors":"James Thiek, Devajyoti Sharma, Akash Guha, Lachit Kalita","doi":"10.25259/ijrsms-2022-12-2","DOIUrl":"https://doi.org/10.25259/ijrsms-2022-12-2","url":null,"abstract":"Background Patients undergoing modified radical mastectomy (MRM)/breast-conserving surgery (BCS) with axillary nodal clearance experience significant post-operative pain, resulting in immobilization and increased usage of analgesics. These factors in turn result in delayed discharge. The pecs 1 and pecs 2 blocks have proven to be of significant benefit in relieving post-operative pain in such patients. [1–7] Objectives A case series was performed at our institute to note the effects of pecs 1 and pecs 2 blocks on post-operative opioid use, early mobilization of the upper limbs, decreased incidence of early post-operative limb swelling and enhanced recovery after surgery. Material and Methods We included six patients who underwent BCS with axillary lymph node dissection/MRM wherein intraoperative pecs 1 and pecs 2 blocks were used. Patients were given pecs 1 and 2 blocks with 10+20 mL 0.25% injection of bupivacaine under ultrasound guidance after induction. Only patients who were American society of anesthesiologists (ASA) class [8] 1 and 2 pre-operatively were included in the study. Results In our study, opioids were completely avoided and it was seen that post-operative pain was adequately controlled with single doses of non-steroidal anti-inflammatory drugs if patients received intra-operative pecs 1 and 2 blocks. The pain control was rather sustained and adequate for the institution of early post-operative physiotherapy and thus early discharge and enhancing recovery after surgery. Conclusion Post-operative analgesia provided by pecs 1 and 2 blocks resulted in adequate and sustained pain control for early institution of upper limb physiotherapy and mobilization of patients after MRM/BCS with axillary lymph node dissection, which subsequently results in decreased incidence of early post-operative oedema of limb on operated side and early recovery after surgery.","PeriodicalId":499227,"journal":{"name":"International journal of recent surgical and medical science","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135477071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives Forearm fractures are very common in all age groups. 81% of forearm fractures happen in children aged above 5 years with the peak of incidence between 9 and 12 years in females and 12 and 15 years in males. In children aged >9 years, remodelling potential is low and re-displacement of fracture after cast application remains a complication (as high as 25%). Quality of casting is an important modifiable risk factor for fracture re-displacement, which can be measured using the Cast index. The purpose of our study was to find out if Cast index should be used as a standard protocol after reduction for assessment of quality of cast. Material and Methods A total number of 40 patients were selected from outpatient department and trauma centre based on inclusion and exclusion criteria. These patients were treated with below elbow (B/E) or above elbow (A/E) cast application. Follow-up was done radiologically using the Cast index at 0, 1, and 4 weeks of cast application. Out of 40 patients, 2 patients were remanipulated at 1-week follow-up. Results Out of 40 cases of paediatric forearm fracture, 30 (75%) cases were male and 10 (25%) were female. Twenty-seven (67.5%) cases belonged to the 5- to 8-year age group. The mean age was 8.4 ± 2.79 years in males and 6.9 ± 2.23 years in females. The mean Cast index of the whole study was 0.802 ± 0.147 (range 0.48–1.21). The mean Cast index for proximal, middle and distal levels was 0.74, 0.85 and 0.76, respectively. Conclusion Cast index is an excellent marker and gives us an analogy about the quality of cast in paediatric forearm fractures. With proper use, it can also be used as a guiding stick for young orthopaedicians. Thus, regular use of Cast index should be encouraged in all orthopaedic centres; especially for paediatric forearm fractures.
{"title":"Cast Index as a Tool for Predicting Re-displacement after Closed Reduction and Cast Immobilisation in Forearm Fractures in the Pediatric Age Group","authors":"Vikas Singhal, Atul Anand, Anmol Arpan Nand, Swapnil Priyadarshi, Vivek Kumar Gupta","doi":"10.25259/ijrsms-2022-10-8","DOIUrl":"https://doi.org/10.25259/ijrsms-2022-10-8","url":null,"abstract":"Objectives Forearm fractures are very common in all age groups. 81% of forearm fractures happen in children aged above 5 years with the peak of incidence between 9 and 12 years in females and 12 and 15 years in males. In children aged >9 years, remodelling potential is low and re-displacement of fracture after cast application remains a complication (as high as 25%). Quality of casting is an important modifiable risk factor for fracture re-displacement, which can be measured using the Cast index. The purpose of our study was to find out if Cast index should be used as a standard protocol after reduction for assessment of quality of cast. Material and Methods A total number of 40 patients were selected from outpatient department and trauma centre based on inclusion and exclusion criteria. These patients were treated with below elbow (B/E) or above elbow (A/E) cast application. Follow-up was done radiologically using the Cast index at 0, 1, and 4 weeks of cast application. Out of 40 patients, 2 patients were remanipulated at 1-week follow-up. Results Out of 40 cases of paediatric forearm fracture, 30 (75%) cases were male and 10 (25%) were female. Twenty-seven (67.5%) cases belonged to the 5- to 8-year age group. The mean age was 8.4 ± 2.79 years in males and 6.9 ± 2.23 years in females. The mean Cast index of the whole study was 0.802 ± 0.147 (range 0.48–1.21). The mean Cast index for proximal, middle and distal levels was 0.74, 0.85 and 0.76, respectively. Conclusion Cast index is an excellent marker and gives us an analogy about the quality of cast in paediatric forearm fractures. With proper use, it can also be used as a guiding stick for young orthopaedicians. Thus, regular use of Cast index should be encouraged in all orthopaedic centres; especially for paediatric forearm fractures.","PeriodicalId":499227,"journal":{"name":"International journal of recent surgical and medical science","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135476946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives Axial Spondyloarthritis is an inflammatory, immune-mediated condition comprising clinically dif- ferentiated ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). Clinically, as the name suggests, nr-axSpA lacks definitive plain X-ray evidence of structural damage to the sacroiliac (SI) joint. This study was undertaken to assess the patients with newly diagnosed nr-axSpA clinically and compare the same with those with radiographic AS. The laboratory profile of patients suffering from nr-axSpA and their outcomes over 3 months were also studied. Material and Method This study was conducted in the department of Medicine over 18 months in a tertiary health care institution, being a prospective observational type done with 43 subjects Results We observed a Major improvement as per ankylosing spondylitis disease activity score (ASDAS) criteria present among 53.49% of subjects, followed by clinically significant improvement among 27.91% of subjects. 18.60% of subjects did not show any improvement. 9.3 % of subjects showed radiological progression. Out of 8 cases that did not show improvement, all presented with lower back pain (LBP) and morning stiffness. 62.5% had peripheral arthritis. 87.5% had Schober’s test positive, flexion, abduction and external rotation (FABER) test (62.50%), and SI joint tenderness was found among 7.5% of subjects. A total of 4 (9.3%) patients showed radiological progression. They all have low back aches and morning stiffness, and 3 have peripheral arthritis at presentation. We found that patients who showed progression had higher mean erythrocyte sedimentation rate (ESR) and C-Reactive protein (CRP) levels (45 and 36.5, respectively) values and very high disease activity as per ASDAS and bath ankylosing spondylitis disease activity index (BASDAI) criteria. Conclusion There is a great scope and need for research to differentiate the magnetic resonance imaging (MRI) changes in the normal population against the patients with spinal diseases to be able to use MRI with precision in patients with non-radiographic axial spondyloarthropathy (nr-axSpA). As assessed, physiotherapy and Non-steroidal anti-inflammatory drugs (NSAIDS) are currently first-line therapy for patients suffering from nr-axSpA.
{"title":"Assessment of Clinical Profile in Patients Suffering from Non-radiographic Axial Spondyloarthropathy","authors":"Saurabh Limaye, Shraddha More, Milind Nadkar, Alhad Mulkalwar, Sujay Jaju, Hunaid Haider","doi":"10.25259/ijrsms-2022-8-4","DOIUrl":"https://doi.org/10.25259/ijrsms-2022-8-4","url":null,"abstract":"Objectives Axial Spondyloarthritis is an inflammatory, immune-mediated condition comprising clinically dif- ferentiated ankylosing spondylitis (AS) and non-radiographic axial spondyloarthritis (nr-axSpA). Clinically, as the name suggests, nr-axSpA lacks definitive plain X-ray evidence of structural damage to the sacroiliac (SI) joint. This study was undertaken to assess the patients with newly diagnosed nr-axSpA clinically and compare the same with those with radiographic AS. The laboratory profile of patients suffering from nr-axSpA and their outcomes over 3 months were also studied. Material and Method This study was conducted in the department of Medicine over 18 months in a tertiary health care institution, being a prospective observational type done with 43 subjects Results We observed a Major improvement as per ankylosing spondylitis disease activity score (ASDAS) criteria present among 53.49% of subjects, followed by clinically significant improvement among 27.91% of subjects. 18.60% of subjects did not show any improvement. 9.3 % of subjects showed radiological progression. Out of 8 cases that did not show improvement, all presented with lower back pain (LBP) and morning stiffness. 62.5% had peripheral arthritis. 87.5% had Schober’s test positive, flexion, abduction and external rotation (FABER) test (62.50%), and SI joint tenderness was found among 7.5% of subjects. A total of 4 (9.3%) patients showed radiological progression. They all have low back aches and morning stiffness, and 3 have peripheral arthritis at presentation. We found that patients who showed progression had higher mean erythrocyte sedimentation rate (ESR) and C-Reactive protein (CRP) levels (45 and 36.5, respectively) values and very high disease activity as per ASDAS and bath ankylosing spondylitis disease activity index (BASDAI) criteria. Conclusion There is a great scope and need for research to differentiate the magnetic resonance imaging (MRI) changes in the normal population against the patients with spinal diseases to be able to use MRI with precision in patients with non-radiographic axial spondyloarthropathy (nr-axSpA). As assessed, physiotherapy and Non-steroidal anti-inflammatory drugs (NSAIDS) are currently first-line therapy for patients suffering from nr-axSpA.","PeriodicalId":499227,"journal":{"name":"International journal of recent surgical and medical science","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134915142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-14DOI: 10.25259/ijrsms-2022-10-9
Lakshya Prateek Rathore, Sanjay Kumar Thakur, Amit Thakur, Sucheta Mahant
Objectives To assess the incidence and degree of malrotation of tibia after fixation with intramedullary nail for tibial shaft fractures and its measurement by computed tomography (CT). The study also aims to assess the value of CT-based torsion angle in such cases. Material and Methods In this prospective study, fifty patients with closed/open fracture of tibia shaft (proximal 1/3, middle 1/3 or distal 1/3) with or without fracture of fibula were chosen and operated with closed/open reduction internal fixation with reamed intramedullary locked nail. Torsion angle calculated by post-operative CT and revision done for selected cases when tibial malrotation was more than 10 degrees than the control (normal side). Results The range of malreduction was from 43 degrees of external rotation to 12 degrees internal rotation. 15 of the 50 (30%) tibia operated showed malrotation and 5 (10%) were above 20 degrees. The repetition of torsion angle showed a variation of 3.2 to 4.3 degrees. Some injury patterns showed more malrotation than the others. Conclusion Assessment of tibial malrotation following intramedullary nailing has shown higher incidence of malalignment than previously reported in the literature. CT-based torsion angle calculation can be used as a reliable indicator of malrotation.
{"title":"Tibial Malrotation after Intramedullary Locked Tibia Nailing and its Computed Tomography-Based Assessment","authors":"Lakshya Prateek Rathore, Sanjay Kumar Thakur, Amit Thakur, Sucheta Mahant","doi":"10.25259/ijrsms-2022-10-9","DOIUrl":"https://doi.org/10.25259/ijrsms-2022-10-9","url":null,"abstract":"Objectives To assess the incidence and degree of malrotation of tibia after fixation with intramedullary nail for tibial shaft fractures and its measurement by computed tomography (CT). The study also aims to assess the value of CT-based torsion angle in such cases. Material and Methods In this prospective study, fifty patients with closed/open fracture of tibia shaft (proximal 1/3, middle 1/3 or distal 1/3) with or without fracture of fibula were chosen and operated with closed/open reduction internal fixation with reamed intramedullary locked nail. Torsion angle calculated by post-operative CT and revision done for selected cases when tibial malrotation was more than 10 degrees than the control (normal side). Results The range of malreduction was from 43 degrees of external rotation to 12 degrees internal rotation. 15 of the 50 (30%) tibia operated showed malrotation and 5 (10%) were above 20 degrees. The repetition of torsion angle showed a variation of 3.2 to 4.3 degrees. Some injury patterns showed more malrotation than the others. Conclusion Assessment of tibial malrotation following intramedullary nailing has shown higher incidence of malalignment than previously reported in the literature. CT-based torsion angle calculation can be used as a reliable indicator of malrotation.","PeriodicalId":499227,"journal":{"name":"International journal of recent surgical and medical science","volume":"215 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134913803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-14DOI: 10.25259/ijrsms-2022-8-5
Mohamed Sajeed, Nasrin Nisha, Sivaraman D, Prabhu T
With preservation of the vascularity of the bone, preservation of the soft tissue envelope and containment of the fracture haematoma, minimally invasive procedures provide fixation in a biologically sound manner. With these in view, this study was conducted to evaluate the technique of surgical management in distal tibial fractures treated by internal fixation with locking compression plate (LCP) and screws through the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. In this cohort study, 21 patients with distal tibial fractures who were admitted to the hospital between November 2014 and August 2016 were tracked for at least 10 weeks and up to 39 weeks. Adults who were fit enough for surgery, both male and female, participated in the study. MIPPO procedures were followed for every case. In this investigation, a total of 21 cases were examined. Eighty-six per cent of cases with proper bone union were able to bear their full weight at or before the 18-week mark. Complete weight bearing was permitted for the final three patients (14%) at or before 39 weeks. Ninety per cent of patients had fracture union rates that were satisfactory to excellent at 23 weeks. Also, delayed unions were noted in three individuals; two cases experienced ankle stiffness, one as a result of prolonged immobilisation and the other as a result of an intra-articular fracture. There were no infections or wound breakdowns during this trial. The MIPPO technique with LCP plates is a good choice when intramedullary nailing is inadequate for metaphyseal and distal tibia shaft fractures. Also, early fracture union is easily accomplished using the MIPPO technique and careful application of these plates.
{"title":"Distal Tibial Fractures – Surgical outcome following Minimally Invasive Percutaneous Plate Osteosynthesis","authors":"Mohamed Sajeed, Nasrin Nisha, Sivaraman D, Prabhu T","doi":"10.25259/ijrsms-2022-8-5","DOIUrl":"https://doi.org/10.25259/ijrsms-2022-8-5","url":null,"abstract":"With preservation of the vascularity of the bone, preservation of the soft tissue envelope and containment of the fracture haematoma, minimally invasive procedures provide fixation in a biologically sound manner. With these in view, this study was conducted to evaluate the technique of surgical management in distal tibial fractures treated by internal fixation with locking compression plate (LCP) and screws through the minimally invasive percutaneous plate osteosynthesis (MIPPO) technique. \u0000\u0000\u0000\u0000In this cohort study, 21 patients with distal tibial fractures who were admitted to the hospital between November 2014 and August 2016 were tracked for at least 10 weeks and up to 39 weeks. Adults who were fit enough for surgery, both male and female, participated in the study. MIPPO procedures were followed for every case. In this investigation, a total of 21 cases were examined.\u0000\u0000\u0000\u0000Eighty-six per cent of cases with proper bone union were able to bear their full weight at or before the 18-week mark. Complete weight bearing was permitted for the final three patients (14%) at or before 39 weeks. Ninety per cent of patients had fracture union rates that were satisfactory to excellent at 23 weeks. Also, delayed unions were noted in three individuals; two cases experienced ankle stiffness, one as a result of prolonged immobilisation and the other as a result of an intra-articular fracture. There were no infections or wound breakdowns during this trial.\u0000\u0000\u0000\u0000The MIPPO technique with LCP plates is a good choice when intramedullary nailing is inadequate for metaphyseal and distal tibia shaft fractures. Also, early fracture union is easily accomplished using the MIPPO technique and careful application of these plates.","PeriodicalId":499227,"journal":{"name":"International journal of recent surgical and medical science","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134915143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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