Early outcomes of posterior cruciate retaining primary total knee arthroplasty in patients of osteoarthritis in Indian population

Background: Total knee replacement arthroplasty today has become the final treatment option for patients with unsalvageable, severely arthritic, painful and deformed knees. In India the numbers of such surgeries are steadily on the rise with bulk of the patients being relatively younger group. Amongst several factors affecting the kinematics of knee, variations in surface geometry and the retention or sacrificing the posterior cruciate ligament is considered especially important. The role of the retaining a PCL on the demographic, clinical and functional parameters of a patient undergoing TKA remains controversial. The aim of the study was to evaluate the outcomes of cruciate retaining primary total knee arthroplasty in patients of osteoarthritis in relation to demographic, clinical and functional parameters.Methods: 20 knees from 12 patients of osteoarthritis including 8 females and 4 males in age group 45-80 years were operated with cruciate retaining implants. The pre and postoperative evaluations were done radiologicaly and clinically using new knee society score. Patients were followed up for minimum 1 year.Results: evaluations of patients revealed good postoperative improvements at subsequent follow up in comparison to preoperative scores. The average range of movement improved by 43.3 degree. The objective, patients satisfaction and functional score improved with scores of 89, 34 and 89.7 at 1 year follow up. The walking distance and staircase climbing, squatting scores also did well. Age did not seem to affect overall outcomes with males having slightly better postoperative scoring overall.Conclusions: In Indian population when the patient is young, high demanding, the retention of cruciate ligaments gives excellent postoperative functionality and objectivity and should be always considered as first choice surgery

Clinical outcomes in management of dislocation of carpometacarpal joints of hand: a rare orthopaedic presentation

Background: Dislocation of carpo-metacarpal (CMC) joints especially involving the 2nd and 3rd or paired dislocations, presents a rare pattern of orthopaedics hand injuries. They are associated with high energy trauma usually involving motorbike accidents. Severe soft tissue inflammation over the affected hand and associated injuries often makes detection of these fractures difficult. They require prompt management at presentation. Failure to be diagnosed and treated at early stage leads to joint stiffness, restrictions of wrist movement, deformity and sometimes ruptures of tendons crossing the wrist. Most of them require open reduction and internal fixation for stabilization. The objective of the study was to clinically evaluate outcomes in management of carpometacarpal joint dislocations.Methods: We prospectively studied 6 cases of CMC dislocation presenting at average of 1week from the original injury. All were clinically and radiologically evaluated. 3 cases were managed with open reduction and internal fixation with K wire and 1with closed manipulation and percutaneous k wire fixation and 1 case by arthrodesis of CMC joint. Functional assessment was done with Quick DASH score at 6 weeks, 3 months, 6 months and 1 year.Results: All the patients went on to have good functional recovery. The average quick DASH score showed improvement from 77.39 to 4.07 over 1 year follow-up. Conclusions: Careful and meticulous examinations of hands are necessary in high velocity trauma cases to avoid missing diagnosis of CMC dislocation. ORIF remains the gold standard treatment which can also be used for cases presenting late, followed by aggressive post-op physiotherapy can lead to excellent recovery of hand function

Clinical outcomes in management of unstable distal radius fractures treated with external fixation and internal fixation: a prospective comparative study

Background: Management of Distal Radius fracture that are inherently unstable is still a matter of debate. There is no conclusive evidence that support one surgical fixation method over another. An attempt was made to analyze patients treated with Ex-Fix and Internal-Fixation for unstable distal radius fractures and evaluate the clinical efficacy of Ex-fix using principles of ligamentotaxis and Internal-fixation and compare functional recovery, fracture healing time and complications.Methods: A prospective trial was undertaken at our hospital with 35 patients,all aged >20 yrs with closed distal radius fracture and divided into two groups: group I (Ex-fix with or without percutaneous k-wire, and JESS) and group II (Int-Fixation) including 14 and 21 patients, respectively. Periodic clinical examination and x-ray review was carried out to find out fracture union, and functional assessment. Patients were followed up for 1 year, 6 months average.Results: Group I consumed significant less operative time, fluoroscopic exposure, reduced hospital stay, quicker post-operative pain relief. Quick DASH score were significantly high in elderly treated with Ex-Fix in comparison to young in which DASH score was higher with internal-fixator. Functional recovery was early with int-fixation but post-operative wrist stiffness was also higher. 2 cases of delayed wound healing &1 case of pin tract infection with ex-fix application was observed. Conclusions: Internal-fixation remains the treatment of choice for unstable distal radius fracture involving the articular surface and in the young, while ext-fixation can be considered as a primary treatment modality in the extra-articular fractures in young or even intra-articular fractures in the elderly

Fast Semi-Supervised Unmixing of Hyperspectral Image by Mutual Coherence Reduction and Recursive PCA

Dictionary pruning step is often employed prior to the sparse unmixing process to improve the performance of library aided unmixing. This paper presents a novel recursive PCA approach for dictionary pruning of linearly mixed hyperspectral data motivated by the low-rank structure of a linearly mixed hyperspectral image. Further, we propose a mutual coherence reduction method for pre-unmixing to enhance the performance of pruning. In the pruning step we, identify the actual image endmembers utilizing the low-rank constraint. We obtain an augmented version of the data by appending each image endmember and compute PCA reconstruction error, which is a convex surrogate of matrix rank. We identify the pruned library elements according to PCA reconstruction error ratio (PRER) and PCA reconstruction error difference (PRED) and employ a recursive formulation for repeated PCA computation. Our proposed formulation identifies the exact endmember set at an affordable computational requirement. Extensive simulated and real image experiments exhibit the efficacy of the proposed algorithm in terms of its accuracy, computational complexity and noise performance

Early outcomes of posterior cruciate retaining primary total knee arthroplasty in patients of osteoarthritis in Indian population

Background: Total knee replacement arthroplasty today has become the final treatment option for patients with unsalvageable, severely arthritic, painful and deformed knees. In India the numbers of such surgeries are steadily on the rise with bulk of the patients being relatively younger group. Amongst several factors affecting the kinematics of knee, variations in surface geometry and the retention or sacrificing the posterior cruciate ligament is considered especially important. The role of the retaining a PCL on the demographic, clinical and functional parameters of a patient undergoing TKA remains controversial. The aim of the study was to evaluate the outcomes of cruciate retaining primary total knee arthroplasty in patients of osteoarthritis in relation to demographic, clinical and functional parameters.Methods: 20 knees from 12 patients of osteoarthritis including 8 females and 4 males in age group 45-80 years were operated with cruciate retaining implants. The pre and postoperative evaluations were done radiologicaly and clinically using new knee society score. Patients were followed up for minimum 1 year.Results: evaluations of patients revealed good postoperative improvements at subsequent follow up in comparison to preoperative scores. The average range of movement improved by 43.3 degree. The objective, patients satisfaction and functional score improved with scores of 89, 34 and 89.7 at 1 year follow up. The walking distance and staircase climbing, squatting scores also did well. Age did not seem to affect overall outcomes with males having slightly better postoperative scoring overall.Conclusions: In Indian population when the patient is young, high demanding, the retention of cruciate ligaments gives excellent postoperative functionality and objectivity and should be always considered as first choice surgery

Clinical outcomes in management of dislocation of carpometacarpal joints of hand: a rare orthopaedic presentation

Background: Dislocation of carpo-metacarpal (CMC) joints especially involving the 2nd and 3rd or paired dislocations, presents a rare pattern of orthopaedics hand injuries. They are associated with high energy trauma usually involving motorbike accidents. Severe soft tissue inflammation over the affected hand and associated injuries often makes detection of these fractures difficult. They require prompt management at presentation. Failure to be diagnosed and treated at early stage leads to joint stiffness, restrictions of wrist movement, deformity and sometimes ruptures of tendons crossing the wrist. Most of them require open reduction and internal fixation for stabilization. The objective of the study was to clinically evaluate outcomes in management of carpometacarpal joint dislocations.Methods: We prospectively studied 6 cases of CMC dislocation presenting at average of 1week from the original injury. All were clinically and radiologically evaluated. 3 cases were managed with open reduction and internal fixation with K wire and 1with closed manipulation and percutaneous k wire fixation and 1 case by arthrodesis of CMC joint. Functional assessment was done with Quick DASH score at 6 weeks, 3 months, 6 months and 1 year.Results: All the patients went on to have good functional recovery. The average quick DASH score showed improvement from 77.39 to 4.07 over 1 year follow-up. Conclusions: Careful and meticulous examinations of hands are necessary in high velocity trauma cases to avoid missing diagnosis of CMC dislocation. ORIF remains the gold standard treatment which can also be used for cases presenting late, followed by aggressive post-op physiotherapy can lead to excellent recovery of hand function