Bone marrow concentrate efficacy in treatment of chronic aseptic nonunion

Background: Bone marrow is a rich source of osteoprogenitor cells that proliferate and differentiate into osteoblasts. Traditionally, autologous iliac bone grafts have been used in treatment of nonunion. This technique has its associated morbidity, which include donor site pain, infection, scarring, and nerve injury. The use of percutaneous bone marrow stem cells (BMSC) avoids these morbidities with comparable clinical results.Methods: We studied twenty patients of aseptic nonunion where bone marrow was aspirated from the anterior iliac crest, concentrated on a cell separator, and then injected into the nonunion site under c-arm guidance. Each nonunion received a relatively same amount of concentrated bone marrow. The volume of callus was calculated by dimensions obtained from RISPACS software in our institution.Results: There was an average of 29,418 mm3 of callus formation with a minimum of 4,455 mm3 and maximum of 68,460. The average time of union was 12 weeks with minimum of 6 weeks and maximum of 24 weeks.Conclusions: The percutaneous bone marrow concentrate injection provides an effective and a safe alternative method for the treatment of a chronic long standing non-union

Outcome following proximal femoral nailing with helical head screw for intertrochanteric and subtrochanteric fractures

Background: Intertrochanteric fractures are seen commonly in two patient groups, older osteopenic patients after a low-energy fall and younger patients involved in high-energy trauma. Early surgical intervention is advocated in the majority of these patients to reduce the complications associated with long-term immobilization.Methods: In this study proximal femoral nailing with helical head screw is used to achieve initial stability and early mobilization of the patients to avoid complications. In 60 patients undergoing proximal femoral nailing with helical head screw for intertrochanteric fractures the results of surgery were meticulously followed.Results: The patients were assed clinically and radiologically for time of union rate of infection stability and implant failure. All fracture in our study unites within 8 months following surgery.Conclusions: Our study concludes that proximal femoral nailing with helical head screw is the best method of treatment for intertrochanteric fracture as it leads to lesser complications

Does obesity, duration of symptoms and pre-operative knee movements amend discharge readiness and outcomes following total knee arthroplasty?

Background: Total knee arthroplasty (TKA) being the definite procedure in degenerative arthritis of the knee is associated with a high cost that includes the cost of implants and in-hospital length of stay (LOS). Incurring such high costs will put a burden on the patients economically, so the goal being the reduction of hospital stay yet improving the functional outcome with better patient satisfaction.Methods: The study design is a retrospective analysis of 1022 patients of primary elective TKA, performed in our institution. The targeted indicators were sex, body mass index (BMI), pre-operative knee range of movements (ROM), knee deformity and duration of symptoms were analyzed.Results: Analyzing these patients, we found the average LOS is 6.4 days, and obesity, pre-op ROM and deformity all play a role to delay the discharge readiness in the patients. Our study showed that LOS after TKA is multifactorial.Conclusions: In acute setting for readiness of discharge the preoperative knee movements, deformity and patients’ functional abilities can be used to segregate patients who may require close monitoring or intensive physiotherapy

Can isolated tibia intramedullary interlocking nailing in fracture distal 1/3rd both bone leg prevent fracture malalignment: will concurrent fibula fixation help?

Background: Different stand point prevails till date concerning fibular osteosynthesis in distal third both bone fracture fixation. This study was done to assess the post op alignment of distal third both bones fracture without fixing Fibula.Methods: A total of 30 patients who had distal 1/3rd extra articular tibia and fibula fractures were included in the study from July 2016 to April 2019. Tibial nailing was done in all cases with care is taken particularly to prevent malalingment of distal fragment. Radiological malalignment were assessed post operatively.Results: Of 30 patients, 5 patients had excellent results and 21 patients had good results, only 4 patients had fair results with valgus and varus malalignment, however these patients did not have any clinical problems associated with these malalignment at one year follow up. No patients had poor results. Valgus tibial malalignment is observed more frequently when fibular fracture is at proximal level.Conclusions: The level of Fibular fracture is important to determine when the fixation of this bone is indicated. Fixing ipsilateral tibial fracture with intramedullary interlocking (IMIL) nailing without fibular synthesis produce no gross change in alignment provided adequate care is taken for intra operative centering of the nail in both AP and lateral views

Pre-operative hypoalbuminemia: overlooked prior knee arthroplasty?

Background: Role of preoperative serum albumin on primary total knee arthroplasty.Methods: A total of 1022 patients who underwent primary knee arthroplasty were collected. All patients were divided into the control group (preoperative serum albumin ≥3.5 g/dl) and case group (preoperative serum albumin <3.5 g/dl). The risk factors of preoperative hypoalbuminemia and the postoperative complications were analyzed.Results: Compared to controls, hypoalbuminemia patients were older (p<0.05 ), had higher risk for any complication such as delayed wound healing, pleural effusion, and pneumonia, lower BMI and longer hospital stay (p<0.001).Conclusions: Preoperative hypoalbuminemia is more frequent in patients who are older, have poor nutritional condition, and have more than two concurrent disorders. Hypoalbuminemia before surgery is linked to a higher risk of postoperative problems