Is fibromyalgia the most common diagnosis amongst female out-patients?

Background: The objectives of this study were to determine the prevalence of fibromyalgia syndrome (FMS) among women coming to outpatient department.Methods: A total of 68,625 female patients were evaluated out of which 47,901 were in the inclusion criteria. The screening protocol included interview items that have been defined as components of FMS using the 1990 American College of Rheumatology (ACR) classification criteria. Data was entered in mx excel sheet and results were analyzed. The socio-demographic data was expressed in proportions.Results: Out of 47,901 female patients, about 40.7% of the patients were diagnosed to have fibromyalgia syndrome (FMS). Out of which the major group of patients belong to married, unskilled women aged between 40-60 years of age. Conclusions: Fibromyalgia syndrome is the commonest diagnosis among the female patients coming to orthopedic outpatient department

Incidence of calcaneal spur in Indian population with heel pain

Background: This is an observational study that was carried out to find out the incidence of calcaneal spur among Indian population with heel pain as it is one of the most commonest complaints of patients coming to out-patient departments.Methods: Radiological assessment with 200 ankle lateral view x rays were taken for patients (100 male and 100 female) with complaints of heel pain.Results: 118 out of 200 patients with heel pain had calcaneal spur either plantar or at achilles insertion or both of which 60% of them were women. Most common age group affected was 40-50 years.Conclusions: Incidence of calcaneal spur in Indian population with heel pain is 59%

Measurement of Insall Salvati ratio and modified Insall Salvati ratio to assess the position of the patella in South Indian population

Background: This is an observational study that was carried out to find the mean Insall Salvati ratio and modified Insall Salvati ratio in people coming to outpatient department requiring radiograph of knee joint..Methods: Radiological assessment of 200 knees which included 100 men and 100 women above the age group of 18,in a period of 6 months for which Insall Salvati and modified Insall Salvati ratio were calculated.Results: The mean Insall Salvati ratio was calculated to be 0.805 and the mean modified Insall Salvati ratio was 0.605 in South Indian.Conclusions: Based on the above study i conclude that majority of South Indian population had patella baja with female predominance

Is intra articular injection of triamcinolone acetonide a better option in management for primary osteoarthritis knee than methylprednisolone acetate?

Background: Intra articular corticosteroid injections are commonly using in management of osteroarthritis of knee. Most commonly used ones are methylprednisolone acetate (MPA) and triamcinolone acetonide (TA). The aim of our study is to compare the efficacy of these two agents in treating osteoarthritis of knee and find out if any one agent is superior to other if so.Methods: Selected patients with symptomatic OA knee with kellgren-Lawrence grade III were given intra articular steroid injections (40 mg TA or 40 mg MPA) and were reassessed on day 0, 1 month, 3 months and 6 months. VAS and Knee society scores were calculated using questionnaire method and compared the scores.Results: The VAS and KSS was improved significantly on day 0,1 month and 6th month and it was found to be increased at 6th month in both the groups and the values were comparable in both the groups. The effect of both the agents last for 3-6 months and the effects found to be maximum at 1st month and the effects starts to wean off at the end of 6 months in both the groups.Conclusions: Both methylprednisolone acetate (MPA) and triamcinolone acetonide (TA) are equally effective in reducing pain in patients with osteoarthritis of knee and thereby improving their functional ability upto 6 months

Is adding intra-articular steroid in total knee arthroplasty cocktail obligatory?

Background: The patients can undergo total knee replacement surgery either under general anaesthesia, combined spinal and epidural anaesthesia, nerve root block, spinal combined with intra-articular knee cocktail. There is an ongoing debate amongst Arthroplasty surgeons whether to include steroid in the cocktail or not. The aim of this study is to assess whether there is an added benefit of including steroid in the intraarticular mixture.Methods: This prospective study was conducted at Sri Ramachandra Institute of Higher education, Chennai between December 2017 to December 2018. The study was conducted in the Arthroplasty unit, Department of Orthopaedics. SRIHER ethics committee clearance was obtained prior to the start of the study. The inclusion criteria were patients who underwent total knee replacement surgery under combined spinal and intra-articular knee cocktail. Patients were divided into two groups based on the use of steroid in the intra-articular mixture. Patients were evaluated using Visual analogue scale, opioids usage as primary endpoint while any joint infection within six months of the surgery and knee society score at 1 month and 6 months as the secondary endpoint.Results: The mean visual analogue score for the 0 pod for the group I and group II were 2.3 and 2.4 respectively. There was no case of infection in both groups.Conclusions: There is no fringe benefit of adding steroid to the knee cocktail. So it is not obligatory to add steroid in intra-articular total knee arthroplasty cocktail

To analyze and use the parameters in post-operative unstable intertrochanteric fractures treated using dynamic hip screw fixation as guidelines for re-operation

Background: The treatment of unstable intertrochanteric fractures is challenging due to the difficulty in obtaining anatomical reduction. The purpose of this study was to analyse and use the parameters (lateral femoral wall integrity and tip-apex distance) in post-operative unstable intertrochanteric fractures treated using dynamic hip screw (DHS) fixation as guidelines for re-operation.Methods: This was a prospective study and included 40 patients with unstable intertrochanteric fractures treated using DHS fixation from December 2014 to September 2016. The AO/OTA classification was used to classify each of the patients and their lateral femoral wall integrity and tip-apex distance was assessed in the post-operative radiographs.Results: In this study, 3 patients out of 40 (7.5%) had screw pull out within 5 months of surgery. 2 pull outs occurred when the screw was in the antero-superior zone and 1 when it was in the centre to centre zone. Thus, the rate of screw pull out was higher in the antero-superior zone. The 3 patients with screw pull out had a mean tip-apex distance (TAD) of 36.01 mm as compared to 32.96 mm of those who did not have screw pull out. We further found that pre-operatively 6 patients out of 40 (15%) had lost lateral femoral wall integrity whereas post-operatively 26 patients out of 40 (65%) had lost it. In summary, there is a 5 times higher risk of losing lateral femoral wall integrity if DHS is the implant of choice. Conclusions: On conclusion, unacceptable TAD limit with loss of lateral femoral wall integrity was found to be a definite indicator of DHS implant pull out. And also found that by using the DHS as an implant of choice, there is a 5 times higher risk of losing lateral femoral wall integrity intra-operatively and that its use for the treatment of unstable intertrochanteric fractures must be guarded

Outcome analysis of surgically managed unstable burst fracture

Background:Burst fractures are common injuries of dorsolumbar spine. In indicated cases, surgery is the treatment of choice. Significant controversy exists regarding surgical intervention for these fractures. Posterior decompression, anterior decompression and instrumentation, and combined anterior decompression and posterior instrumentation have been recommended in various studies. Here we are going to evaluate unstable burst fractures of thoracic and lumbar spine treated by isolated anterior decompression and instrumented fusion with TSM-Bone graft composite.Methods: Prospective study of thirty-six cases of unstable fracture of thoracic and lumbar spine treated in Sri Ramachandra Medical centre from January 2011 to January 2014. The inclusion criteria were burst fractures of thoracic or lumbar spine complete or incomplete neurological deficit and burst fractures of thoracic or lumbar spine without neurological deficit but with mechanical instability. The exclusion criteria were pathological fractures, chance fracture, stable burst, wedge compression and osteoporotic compression fractures. The results were analyzed during the follow-up using the Pain – Visual analogue scale, Fusion status and radiographic parameter – K-angle .For pain score were given as 3,2,1 for absent, moderate and severe pain respectively. Regarding fusion status score of 3,2,1 were given when fusion was good, fair and no sign of fusion respectively.Results:Mean pre-operative K-angle was 28o. Average loss of correction at final follow up was 3o.Mean correction of K-angle was 140.Moderate to severe loss of correction of K- angle was observed in 4 patients. Mild to moderate pain in 5 patients treated with analgesics. Average TSM subsidence was 3mm.Conclusions:Bone graft composite provides stable biomechanical support to deficient anterior column in burst fractures and allows early rehabilitation and mobilization. Neural recovery may occur after anterior decompression, stabilization and fusion with TSM-Bone graft composite in dorsolumbar burst fractures with incomplete cord injury

Functional and radiological analysis of posterior lumbar interbody fusion in spondylolisthesis

Background:Spondylolisthesis is present in 5% of the adult population with clinical evidence of low back pain. These patients are treated initially by conservative measures, failing of which surgical intervention is mandatory. Majority of patients with varying degree of slip and disability ultimately require surgical intervention. In this study we are trying to analyse the functional outcome following posterior lumbar interbody fusion in spondylolisthesis.Methods: Posterior lumbar interbody fusion using pedicle screw and rods with cage was performed on 25 patients. 6 months follow-up was completed in 25 patients who were then reviewed at regular intervals. Out of the 25 patients, 17(68%) were females and 8(32%) were males. The mean age of the patients was 40.64 years. Out of 25 patients, 14 patients had listhesis at L4 – L5 level and another 11 at L5 – S1 level. 21(84%) were Isthmic variant and 4 (16%) were Degenerative spondylolisthesis.Results:The mean follow up period in this study of 25 patients is 19 months. Out of 25 patients, there was mean improvement of 18.96 in the Oswestry scoring index. The Visual analogue scale score showed a mean improvement of 6.48. Radiologically, the percentage of slip was decreased by a mean of 8.40%. One patient had a cage extrusion with no neurological deficit.Conclusions:The pedicle screw with rod and cage system is easy to use and provides the anatomic restoration of the isthmus in isthmic spondylolisthesis or restoring the stability after laminectomy/discectomy in degenerative spondylolisthesis. From our study, we strongly believe that this technique is very useful in low grade degenerative and isthmic spondylolisthesis

A rare case of patellar fracture with quadriceps tendon rupture

Quadriceps tendon rupture is the rarest injury with an incidence of 1.37/1,00,000/year. A patellar fracture is the most common injury associated with extensor mechanism lag, but it is rarely found to have quadriceps rupture rather than patellar tendon rupture. Normally when patella fracture occurs the force is disseminated at the bone level rather than at the muscular level. In this case, the force has disseminated at both muscle and bone leading to fracture of patella and quadriceps tendon rupture. Here we report a case of patellar fracture along with quadriceps tendon rupture

Management of infected custom mega prosthesis by Ilizarov method

A 26 year old male patient with an aggressive giant cell tumour of the left distal femur was managed by wide excision and insertion of custom mega prosthesis. Patient developed deep infection which did not subside with multiple debridements and antibiotics.  Hence the custom mega prosthesis was removed and the bone gap was managed by Ilizarov method.  Ilizarov fixation of the left femur and tibia was done.  Femoral and tibial corticotomy was done and the bone segments were transported towards the knee to finally achieve a knee arthrodesis.  The case illustrates the method and difficulties encountered during the treatment