Comparative analysis of the clinical, functional and radiological outcomes of proximal femoral nail alone verses proximal femoral nail along with lateral wall plating in management of unstable intertrochanteric femur fracture, AO/OTA, type 31A2 fractures with deficient lateral wall

Background: The objective of the study was to compare the effectiveness in terms of clinical, functional and radiological outcomes of management of unstable intertrochanteric femur fracture, AO/OTA type 31A2 intertrochanteric fractures with deficient lateral wall with proximal femoral nail (PFN) alone verses PFN along with lateral wall plating. Methods: In our study 52 patients with intertrochanteric femur fractures, AO/OTA type 31A2 which met the selection criteria were divided into two groups, group A (PFN) with lateral wall plating and group B (PFN) alone by randomization and were analysed prospectively with no significant difference in terms of gender, age, side of injury, cause of injury, and combined medical diseases. The intraoperative time and blood loss, time to full weight-bearing and radiological union, varus collapse, functional outcome and postoperative complications were recorded and compared. Results: Comparatively, no significant difference was observed between both groups for the time for full weight bearing. However significant difference was observed between both the groups for HHS at 9 months, neck shaft angle and time for radiological union (in weeks). Statistically significant difference was observed between both the groups for neck shaft angle and HHS at 9 months. The incidence of complications was 30.77% in group B. The incidence of complications was around 26.92% in group A; with no significant difference. At 9 months after operation, the Harris scores of pain, function, malunion, range of motion, and total score in group A were significantly better than those in group B. Conclusions: For unstable intertrochanteric femur fracture with incomplete lateral wall, the incidence of varus collapse after augmentation of PFN fixation with lateral wall plating was lower, the time for radiological union was earlier and functional outcome was better

Mini open anterolateral rotator cuff tear repair with the help of suture anchor

Background: It is generally accepted that mini open rotator cuff tear repair with the help of suture anchor gives satisfactory results in the long term, although most studies have so far shown a fairly high rate of good structural and functional outcome. The purpose of this study is to asses functional outcome of mini-open anterolateral rotator cuff tear repair with the help of suture anchor. Method: The 30 consecutive rotator cuff tear patients were selected from outpatient department at medical college. All patients were diagnosed with full thickness rotator cuff tear and subsequently treated with mini-open anterolateral approach technique. Each patient was clinically assessed with DASH questionnaire and constant Murley score for their satisfaction. Results: After a minimum of 12 month follow up period, the average clinical outcome scores all improved significantly at the time of final follow up. Conclusions: Patient with mini-open anterolateral rotator cuff tear repair with the help of anchor suture showed improvement in their functional outcome and range of motion.

Comparative outcome assessment of total hip arthroplasty versus bipolar hemiarthroplasty in intracapsular neck of femur fracture in old age

Background: This prospective study aimed to compare the outcomes of total hip replacement (THR) and bipolar hemiarthroplasty for the treatment of displaced femoral neck fractures in elderly patients. Methods: A total of 30 patients aged over 60 years with femoral neck fractures were included in the study, with 15 patients receiving a bipolar prosthesis and patients receiving THR between June 2021 and January 2023. The patients were followed up for 6 months postoperatively, with functional analysis conducted using the modified Harris hip score. Results: The results showed that the modified Harris hip score was significantly higher in the THR group compared to the bipolar prosthesis group at day 1, 3, 6 and 12 months postoperatively. Pain levels were similar between the two groups at all follow-up intervals. Gait and range of motion were significantly higher in the THR group compared to the bipolar prosthesis group at all-time points. Conclusions: Based on the short-term functional outcomes of this study, THR appears to be a preferable option over bipolar prosthesis for managing femoral neck fractures in elderly

Orif of lateral Hoffa's fracture with irreducible patella dislocation and incarcerated patella in lateral Hoffa's fragment: rare injury presentation

Majority of lateral Hoffa fracture are associated with knee injury. Presenting a case of 30-years-old gentleman who presented with pain, swelling, deformity in knee of right side after road traffic accident.  On local examination there was marked swelling with inability to palpate patella, inability to flex knee. On clinical examination, there was patella dislocation as it was not in place and unable to reduce. Radiological investigation showed a lateral Hoffa's fracture with dislocation of patella and patella being incarcerated in Hoffa fragment. Operative and follow up: Patient was operated by open reduction of patella dislocation and CC screw fixation for lateral Hoffa fracture. On six weeks follow up normal ROM achieved. Patient was surgically treated to relocate locked patella fragment in Hoffa's fragment and fix Hoffa's fragment and achieved good range of motion

Evaluation of clinical and functional outcome of total hip arthroplasty in avascular necrosis of head of femur in adults

Background: Aim of the study was to evaluate clinical and functional outcome of bipolar hemiarthroplasty in avascular necrosis (AVN) of HIP in adults. Methods: Thirty patients of either sex between age group 20-80 years of age came for the treatment at government medical college and hospital Aurangabad. Between December 2020 to December 2022. Patients were followed every day till the discharge. Patients were discharged after they were mobilised with assistance of physiotherapist. Functional and clinical outcome was measured at 6, 12 and 24 weeks postoperatively according to Harris hip score (HHS). Results: the methods show significant improvement in HHS in patient undergoing total hip replacement. Conclusions: total hip replacement is a very good option for AVN of head of femur in all age groups

Assessment of the effect of low-cost negative pressure dressing on wound healing

Background: Wound care is a priority element in the management of grade 3 compound fractures and has traditionally relied on the use of dressing products (gauze, foam dressings, alginates, and hydrocolloids) and manual debridement. Paving the way to the future, there are now several alternative therapies, of which negative pressure wound therapy (NPWT) is an emerging treatment. Negative suction dressing has been proven to be superior in wound healing and is faster compared with regular dressing using gauze, hydrocolloids, and local debridement. It leads to faster rates of skin cover spontaneously or with surgical procedures like skin graft and flaps, eventually resulting in early internal fixation of fractured bones, if any.  The present study was designed to assess the effect of the negative pressure dressing technique on wound healing and to compare its effect with that of the conventional dressing technique. Methods: The study was a double-blind randomized control trial conducted after ethics approval. A case record form was used for data collection after obtaining the participants’ informed consent, and a total of 120 patients participated in the study. Results: Low-cost negative pressure dressing has an effect on general conditions, fever, hyperemia, and irregular margins. It was observed to increase granulation tissue formation and decrease pus/serous discharge and was associated with a decreased number of hospital visits due to early healing compared with normal dressing. Conclusions: The low-cost negative dressing technique was effective in healing wounds in type III open fractures and was associated with early recovery compared with the normal dressing technique

Management of patella fracture with percutaneous wiring

Patella fractures are fixed traditionally in orthopaedics by open reduction and internal fixation as it is an intra-articular fracture. Open operative techniques are associated with high incidence of infections, cosmetic problems, and delayed rehabilitation. Percutaneous, arthroscopic techniques have fewer complications but these are technically demanding procedures to master. Percutaneous wiring of patella being a newer technique, in our study of 25 patients we evaluated its results over other conventional methods of treatment of patella fracture. The patients were followed up for 30 months and its results were studied

Accelerated Stability Study of Kailas Jeevan – A Proprietary Ayurvedic formulation

Background: Stability studies are the test to assess the shelf life of the Ayurvedic proprietary medicines. Govt. of India made mandatary test for licencing and renewal of licencing of the proprietary medicine. Accelerated stability studies, testing interval of 0,3 and 6 months.  Kailas Jeevan is a proprietary semisolid dosage form prepared in GMP approved Ayurveda Sumshodanalaya (P) Pvt. Ltd. Dhayri, Pune. It is indicated in Constipation, Cracked heels, Wounds, Pimples, Burns etc. Aims and Objectives: To evaluate the shelf life of Kailas Jeevan through accelerated stability study. Materials and Methods: The formulation was prepared in the GMP approved pharmacy. Shelf life of product was evaluated by assessing in changes in physicochemical, Microbial and quantification profiles, after keeping it in stability chamber at specific temperature (40±2°C) and relative humidity (75±5%). Analysis was carried out at the intervals of 0, 1, 3, 6, 9,12, 18 and 24 months. Average 25% degradation time was calculated to find the shelf life as per the Ayurvedic Pharmacopoea of India, Part I Vol ix guidelines. Results and Conclusion: The parameters assessed in accelerated study of Kailas Jeevan, was shown under limits till 24 months. Based on multiplication factor shelf life of Kailas Jeevan is 7.02 year. Key Words: Stability, Shelf life, Kailas Jeevan, Accelerated stability study &nbsp