A COHORT STUDY COMPARING SHOULDER PRIMARY ADHESIVE CAPSULITIS TREATMENT WITH ARTHROSCOPIC CAPSULAR RELEASE, SUBACROMIAL DECOMPRESSION, ROTATOR INTERVAL RELEASE AND MANIPULATION UNDER GENERAL ANESTHESIA

Background In 90% of cases, adhesive capsulitis is manageable using conservative management strategies but it requires optimum surgical intervention if it is not cured with conservative strategies. This study aims to compare the combination of arthroscopic capsular release and rotator interval release and manipulation under general anesthesia.  Method A total of 120 patients who did not respond to conservative management strategies were included in this study. They were divided into two groups: 60 patients underwent manipulation under general anesthesia (GA) alone, and the other 60 patients received a combination of arthroscopic capsular release, rotator interval release, and manipulation under GA. Visual Analog Scale (VAS) and the Oxford Shoulder Score (OSS)were recorded before surgery and at follow-ups after one week, one month, three months, and six months.  Results Both VAS and OSS declined significantly in both groups. For the manipulation under the GA group, the OSS decreased from 49.8±3.3 to 30±4.4 after six months, while the combination group saw a reduction from 50.1±4.4 to 17.4±3.0 after six months. Similarly, the VAS decreased from 6.65±0.93 to 1.47±0.8 in the manipulation group, and from 7.6±1.0 to 0.29±0.47 in the combination group after six months. The combination procedure showed significantly better outcomes in terms of both pain reduction and improved shoulder function (p<0.001).  Conclusion The combination of arthroscopic capsular release, rotator interval release, and manipulation under general anesthesia provides significantly better outcomes than manipulation under general anesthesia alone for adhesive capsulitis, as evidenced by improvements in VAS and OSS over six months.  Recommendation Symptoms and stages of adhesive capsulitis should be taken into consideration while selecting the best possible conservative management strategy and surgical intervention

A PROSPECTIVE STUDY EXAMINING THE CLINICAL AND FUNCTIONAL OUTCOMES OF ADULTS WITH PROXIMAL HUMERUS FRACTURES TREATED USING A LOCKING COMPRESSION PLATE (LCP): A COHORT STUDY.

  Background Proximal humerus fractures (PHF) are common, particularly among the elderly, and can significantly impact functional outcomes. The introduction of locking compression plates (LCP) has enhanced the management of these complex fractures by providing stable fixation. The study assessed the clinical and functional results of locking compression plate treatment for PHF in adult patients.  Methods Included were 150 patients who had closed proximal humerus fractures that were categorized as 2-, 3-, or 4-part fractures according to NEER guidelines. Using a deltopectoral technique, patients received open reduction and internal fixation with LCP. The Constant-Murley scoring system was used to estimate clinical and functional outcomes, such as pain, daily living activities, range of motion (ROM), and muscle power. There were follow-ups at two weeks, six weeks, three months, six months, and a year. The statistical analysis was carried out with SPSS 23.0.  Results The study included participants with a mean age of 38.6 years, 56.7% males​. Significant improvements were observed in all outcome measures. Pain scores decreased from a preoperative mean of 12.5 to 2.1 at one year. Activities of daily living scores improved from 10.3 to 20.0. ROM increased from 22.3 degrees to 80.2 degrees, and muscle power improved from 14.7 to 24.3. Complications were noted in 12% of cases, including infection, hardware failure, nonunion, and subacromial impingement. Statistical analysis confirmed these improvements were highly significant (p < 0.001).  Conclusion Locking compression plates effectively improves clinical and functional outcomes for proximal humerus fractures. The significant reduction in pain and enhancement in ROM and muscle power support the use of LCPs in managing these complex fractures.  Recommendations Further studies should focus on long-term outcomes and strategies to minimize complications associated with LCPs. Additionally, patient selection criteria and individualized treatment protocols should be optimized based on specific fracture patterns and patient characteristics

A PROSPECTIVE COHORT STUDY ON CLINICAL OUTCOME OF SURGICALLY TREATED ACETABULAR FRACTURE, PATNA, INDIA.

Background The aim of the study is to evaluate the efficacy and outcomes of open reduction internal fixation (ORIF) as a surgical treatment for acetabular fractures. Specifically, the study seeks to assess the restoration of hip function, the incidence of postoperative complications, and the long-term health of the joint following surgical intervention, to determine the effectiveness of this treatment approach across different patient demographics. Method  This study was carried out prospectively at the Department of Orthopaedics, IGIMS, Patna for 4 years. In total 50 patients participated in the study. All of them had fractures in their acetabulum. They were treated with open reduction internal fixation surgery for their fractures. screws and plates were used for the reconstruction. The patients followed up for a period of 2 and half years. Results In total 50 patients participated in the study, the outcome of the last follow-up showed that in 80% of the patients, the functional abilities of the hip bone were restored. As for the complications, osteoarthritis was found in 3 patients, Heterotopic ossification was reported in 2 patients, nerve injury in 1, dermal infection in 2, necrosis of the blood vessel in 2, and imperfect reduction in 1 patient. Conclusion  Early treatment and longer follow-up improve the outcome of the reduction fixation irrespective of the age and bone health of the patients Recommendation Early diagnosis, treatment, and longer duration of effective follow-up improve the outcome of acetabular fracture reduction

EXAMINING MORTALITY RATES FOLLOWING PERIPROSTHETIC FEMUR FRACTURES IN PATIENTS UNDERGOING PRIMARY AND REVISION TOTAL HIP ARTHROPLASTY: RETROSPECTIVE COHORT RESEARCH

Introduction Following total knee and hip arthroplasty (TKA and THA), periprosthetic fractures (PPF) have risen. The study evaluated morbidity and mortality after PPF surgery for the knee and hip.  Methods A level-1 trauma center examined 248 patients, throughout two years. These patients were included retrospectively. Mortality was taken into consideration as the main event in Fine and Gray's model when assessing risk factors for postoperative morbidity. Cox regression models, both univariate and multivariate, were used to identify death risk variables.  Result The mean age was 77 years; 77.40% were female with PPF of the hip (n = 194) and knee (n = 54). Out of all the fracture types in Vancouver, B2 (n = 78; 42.4%) was the most common, followed by B1 (n = 46; 25.00%). Form I fractures (n=28; 51.9%) were the most common form of Lewis-Rorabeck fracture in the PPF of the knee. Complication rates for PPF of the knee and hip were 44.0% and 29.9%, respectively. Six patients experienced early and late problems, 50 had early complications, and 38 had late implant-related complications that required surgery.  Conclusion Younger patients and those undergoing ORIF have higher postoperative morbidity from implant issues. Accounting for mortality prevents underestimating complications. The retrospective study at a level 1 trauma hospital shows that, with careful planning, surgeries longer than two days do not harm patient outcomes.  Recommendation An earlier study found that for patients with native hip fractures or periprosthetic fractures, surgery is still advised 24 to 48 hours after admission

CLINICAL OUTCOME OF SURGICALLY TREATED ACETABULAR FRACTURE: A PROSPECTIVE STUDY.

Background:  Fractures in the acetabulum usually require surgical intervention. The surgical procedure is to reduce the fracture and its fixation internally. Intraoperative and postoperative complication associated with the surgery makes the surgery challenging. Method:  This study was carried out prospectively at the Department of Orthopaedics, IGIMS, Patna for 4 years. In total 50 patients participated in the study. All of them had fractures in their acetabulum. They were treated with open reduction internal fixation surgery for their fractures. screws and plates were used for the reconstruction. The patients followed up for a period of 2 and a half years. Results:  In total 50 patients participated in the study, the outcome of the last follow-up showed that in 80% of the patients, the functional abilities of the hip bone were restored. As for the complications, osteoarthritis was found in 3 patients, Heterotopic ossification was reported in 2 patients, nerve injury in 1, dermal infection in 2, necrosis of the blood vessel in 2, and imperfect reduction in 1 patient. Conclusion:  Early treatment and longer follow-up improve the outcome of the reduction fixation irrespective of the age and bone health of the patients Recommendation:  Early diagnosis, treatment, and longer duration of effective follow-up improves the outcome of acetabular fracture reduction

A Comparative Evaluation of Gustafson’s Formula and New Formula for Age Estimation in India – A Forensic Study

The choice to use teeth for age determination is well accepted due to their longevity ability of being resilient to change. The total of 228 extracted teeth collected from the patients visited to the Department of Oral and Maxillofacial Surgery, NIMS Dental College, Jaipur, the teeth were without dental fillings and without and/or cavity selected. The known age was from 21 to 70 years with the average age of 43.46 years. For age estimation the method according to Gustafson was used. Every tooth was subject to longitudinal section of the midpulpal area. The following dental parameters were studied in each case: attrition, periodontal bone loss, root translucency, secondary dentin deposition, cementum apposition and root resorption. Total scores of different parameters plotted against the chronological age and regression formula was obtained. Using this formula ages were estimated, Gustafson formula was also applied in the same scores and ages estimated. The results of the chronological and estimated age by both formulae have been statistically compared using Pearson’s correlation and regression analysis. The results showed strong correlation (0.92; p<0.001) between chronological and estimated age by using both formulae. We found the mean error of ± 5.47 by using newly derived and formula and ± 6.35 by Gustafson’s formula. As a result of our study it was found that newly derived formula provides better results in comparison with Gustafson’s formula in Indian population. A positive correlation between age and total scores of physiological changes also revealed

Knowledge, attitude, and practice patterns of Indian ophthalmologists regarding medicolegal issues

Purpose: To assess the knowledge, attitude, and practice patterns (KAPP) of Indian ophthalmologists regarding medicolegal issues using an initial survey. Methods: An online form was circulated among Indian ophthalmologists of all ages over social media and email by the Young Ophthalmologists Society of India (YOSI) and its medicolegal working group. Anonymous responses were obtained and analyzed for each question. The questionnaire comprised questions about demographic details, KAPP of medicolegal issues including how to deal with medicolegal issues (if faced), medical indemnity insurance, deviation from the recommended minimum sum assured (Rs. 1 crore for Indian ophthalmologists), and legal service providers. Results: A total of 109 responses were obtained. The majority of the respondents were male (60, 55%). More than 50% of respondents (58, 53.2%) were younger than 35 years. More than one-fourth of the respondents were private practitioners (29, 27%), and the majority were of senior consultant designation (45, 41%). Around 80% of respondents (89, 81.6%) were aware of professional indemnity insurance; however, only 54% (n = 59) bought the insurance cover. A majority of the respondents (38, 64.4%) had an indemnity cover of a maximum of Rs. 50 lacs. Only 20% of respondents were aware of the expert body at the state/national level that deals with medicolegal cases. Thirty percent of respondents recommended the ideal cover amount to be more than Rs. 1 crore. Conclusion: The current survey highlights the dismally low rate of awareness of medicolegal issues among ophthalmologists. Specifically, a majority of Indian ophthalmologists surveyed did not have recommended minimum insured cover for professional indemnity insurance. Larger studies are needed to further explore KAPP of Indian ophthalmologists in various medicolegal issues