Calcaneal fractures: a management dilemma-minimally invasive approach for intra and extra articular calcaneal fractures

Background: Calcaneal fractures which constitutes 2% of total fractures are frequent and very debilitating if not treated properly. Calcaneal fractures generally affect younger population leading to significant man-days loss(around 2-5 years3) and in-turn leading significant economic burden on the society. The goal of treatment for calcaneal fractures is elimination of pain and restoration of normal foot shape, biomechanics, and walking ability. Wound related complications are common with open surgeries. After open reduction internal fixation with perimeter plates for displaced calcaneal fractures, wound edge necrosis is commonly observed with the extended lateral approach. Because of such high incidence of wound complications in open reduction of calcaneum fractures, minimally invasive approach takes priority over open reduction of these fractures.Methods: The study aimed to evaluate the results of minimally invasive approach for calcaneal fractures. To reduce the operative complications, 30 patients were treated with minimally invasive methods in both extra articular and intra-articular calcaneal fractures and the results were evaluated. All patients were evaluated clinically , functionally and radiologically 3D- CT reconstruction images.Results: All cases were followed up for 2 years at specified intervals. The outcome measures were evaluated by AOFAS scores10 with excellent result in 13 cases and good to fair results in the rest. Operated patients had no wound infection, no skin necrosis, 5 patients had mild subtalar arthrosis and 3 patients complained slight difficulty in wearing shoes. None of them have any gait abnormalities.Conclusions: Our study suggests that the minimally invasive methods will reduce the operative complication rates. The minimally invasive surgical intervention in an expert hand can yield better results with less complication rates

Drainage in primary cemented total knee arthroplasty required or not? A comparative study among northern Indian subjects

Background: Although there is no established evidence to support the use of drains in total knee arthroplasty (TKA), they are thought to reduce the formation of a haematoma and the incidence of deep infection. The aim of the study was planned to assess the need for drainage after total knee arthroplasty.Methods: For this comparative evaluation, a total of 100 patients were recruited into two groups. Group A consisted of 50 knees, in which drain was not used after TKA and a control group, group B with 50 knees, in which drain was inserted after TKA. Thus group A was study/ no drain group whereas group B was control/drain group. Pain intensity and analgesic intake were assessed as primary outcome factors. Visual analog scale (VAS) assessed pain intensity. Intake of analgesics was determined. Requirement for dressing reinforcement and the length of hospital stay were also evaluated.Results: Patients in the study group required approximately three times less opioids than patients in the control group (mean analgesia request amounted 0.16 and 0.45/patient, respectively). Overall mean pain score was higher in group B than in group A. In the study group every patient needed the dressing to be changed at an average 4.6±1.2 times during hospitalization compared with 5.3±1.2 times in the control group. Regarding differences in the pattern in the range of motion and length of hospital stay between the groups, there was no much difference. All the study subjects achieved full extension of the operated knee at discharge.Conclusions: On the basis of empirical evidences of this study it can be concluded that there is no rationale for the use of drain after primary cemented total knee arthroplasty. Use of drains in after primary cemented total knee arthroplasty has not much to offer

Drainage in primary cemented total knee arthroplasty required or not? A comparative study among northern Indian subjects

Background: Although there is no established evidence to support the use of drains in total knee arthroplasty (TKA), they are thought to reduce the formation of a haematoma and the incidence of deep infection. The aim of the study was planned to assess the need for drainage after total knee arthroplasty.Methods: For this comparative evaluation, a total of 100 patients were recruited into two groups. Group A consisted of 50 knees, in which drain was not used after TKA and a control group, group B with 50 knees, in which drain was inserted after TKA. Thus group A was study/ no drain group whereas group B was control/drain group. Pain intensity and analgesic intake were assessed as primary outcome factors. Visual analog scale (VAS) assessed pain intensity. Intake of analgesics was determined. Requirement for dressing reinforcement and the length of hospital stay were also evaluated.Results: Patients in the study group required approximately three times less opioids than patients in the control group (mean analgesia request amounted 0.16 and 0.45/patient, respectively). Overall mean pain score was higher in group B than in group A. In the study group every patient needed the dressing to be changed at an average 4.6±1.2 times during hospitalization compared with 5.3±1.2 times in the control group. Regarding differences in the pattern in the range of motion and length of hospital stay between the groups, there was no much difference. All the study subjects achieved full extension of the operated knee at discharge.Conclusions: On the basis of empirical evidences of this study it can be concluded that there is no rationale for the use of drain after primary cemented total knee arthroplasty. Use of drains in after primary cemented total knee arthroplasty has not much to offer