Results of management of spinal tuberculosis according to middle path regime and short course chemotheraphy

Background: Vertebral tuberculosis is the most common form of skeletal tuberculosis and it contributes about 50 percent of all cases of skeletal tuberculosis. The purpose of this study is to delineate the importance of middle path regime and short course chemotheraphy in the management of spine tuberculosis.Methods: A prospective study was conducted which included 44 patients diagnosed as tuberculous spondylitis. Management was started as per middle path regime and drugs were given as per the revised national tuberculosis control program (RNTCP) regime category I under directly observed treatment, short-course (DOTS) therapy. Specimen was collected and studied for smear, culture, antibiotic sensitivity and histopathology. ATT was stopped at the end of 6 months as per DOTS schedule and MRI was done at the end of therapy.Results: Dorsal spine lesions were found in 33 patients. 8 patients were smear positive and 38 patients were culture positive of whom 26 patients were sensitive to first line ATT drugs. 12 patients had MDR tuberculosis and were sensitive to 2nd line ATT drugs. 6 patients having negative culture were diagnosed from histopathology. All patients on 1st line ATT had satisfactory result. Only 8 patients with MDR tuberculosis recovered neurologically. Conclusions: It is mandatory to do obtain tissue biopsy and examine culture, sensitivity and histopathology. Recently there is an increasing tendency in multidrug resistance cases and total drug resistant cases. By doing culture and sensitivity of the specimen we can find out the number of MDR cases and initiate proper drug regimen to avoid further complication and mortality

Assessing the prevalence of various modes of injury and type of malleolar fractures based on Lauge-Hansen classification presenting at a tertiary care center

Background: Ankle fractures represent approximately 9% of all fractures and are a common occurrence with an incidence of 138-169 per 100,000 per year. The mechanism of injury differs in terms of mode of injury in various age groups. The Lague-Hansen classification is a pathologic-anatomic classification and emphasizes different stages of ligamentous injury, in addition to the fracture pattern, and provides options for fracture treatment.Methods: A retrospective observational study, where the prevalence of various types of ankle fractures were classified according to the Lauge-Hansen Classification, in the period of 2018 onwards till date. The mode of injury and age group of the patient was also noted.Results: A total of 84 patients were analyzed, supination-external rotation (48.7%) were the most frequently observed fractures in our study population, with no significant correlation between mode of injury and fracture pattern noted. There was a statistically significant association (p<0.05) between the velocity of injury and the age groups suffering ankle trauma.Conclusion: The Lauge-Hansen Classification continues to be an important tool in assessing the biomechanics of ankle fractures and the management options available, especially in a country like India where more expensive imaging modalities may not be available or affordable at times. Our study also highlights that high velocity fractures continue to be a major cause of morbidity in the younger age group, especially in developing countries such as India. Stringent traffic rules and public awareness need to be put into practice to reduce the toll of this problem

Etiological pattern of problems in an orthopaedics outpatient department of a tertiary care center

Background: Outpatient orthopaedics department of a tertiary care hospital sees large number of patients. However, the funds and resources are limited and have to be judiciously distributed. This study aims to study the etiological pattern of different patients that present to the outpatient department (OPD).Methods: Nine consecutive OPD’s data was studied for the etiology of the different diagnosis of new patients presenting to the OPD. Etiology of various diagnoses was studied as a percentage of the total patients.Results: Trauma of upper limb and lower limb formed a higher percentage of the total patients. Degenerative spine was more common than traumatic spine.Conclusions: Traumatic conditions of the lower and upper limb make up majority of the cases. Degenerative spine is more common than the traumatic etiology

Assessment of functional outcome of surgical management of proximal humerus fracture treated with PHILOS plate

Background: Proximal humeral fractures were treated conservatively in the past and often had compromised functional results. With the advancement of surgical techniques, these fractures, especially displaced, are now more often managed operatively; to meet the needs of the patient, provide early rehabilitation and better functional outcome. The aim of this study was to assess the functional outcome of operative management of proximal humeral fractures with Philos plate fixation.Methods: In this prospective study, 30 patients aged 19-75 years (mean age 47.1 years) with fractures of the proximal humerus, including two-, three-, and four-part fractures, were treated by open reduction internal fixation with Philos plating. Patients’ functional outcomes were evaluated based on subjective (35 points) and objective (65 points) parameters, as per the constant scoring system.Results: Functional outcome based on the constant scoring system of the patient at 6 month follow-up were compared. Excellent results were seen in 12 patients (40%), 2 had very good results (6.66%), 9 patients were having good (30%) and 6 had fair (20%) functional outcome. One patient had poor functional results (3.33%). Avascular necrosis (AVN) of the humeral head was observed in one patients.Conclusions: Philos plate fixation for proximal humeral fractures provides good stable fixation with good functional outcome and is a feasible option.