Outcome analysis of primary cemented bipolar hemiarthroplasty in elderly unstable intertrochanteric fractures during covid phase in Central India

Background: The incidence of inter-trochanteric fractures of the femur is very high in the elderly population. The world-wide incidence of all hip fractures is around 402 per 100000 and the incidence of Intertrochanteric fracture is estimated to be around 171 per 100000 in 2019. All the operative conditions were different during covid phase. We needed early ambulation of our patients for a faster recovery and avoid long stay in hospitals. Methods: 30 patients with unstable intertrochanteric fractures were operated by bipolar hemiarthroplasty during the covid phase. All the patients were followed up at 2, 6, 10 and 16 weeks. Harris hip score and FIM score were assessed. Results: Mean Harris hip score achieved was 87 at 16 weeks and mean FIM score achieved was 78.9 at 16 weeks indicating good functional outcomes. The outcome was excellent in 23.4%, good in 63.3%, fair in 10% and poor in 3.3% as per HHS. Conclusions: This procedure offered pain free mobile hip with early mobilization, easy rehabilitation and early return to functional level, when standard techniques were used

Incidence and location of deep vein thrombosis of lower extremity following surgery of tibial plateau fracture

Background: Tibial plateau fractures are commonly seen fractures of lower limb. They are challenging to manage since they are mostly associated with soft tissue injuries. Deep vein thrombosis (DVT) is a significant cause of morbidity and pulmonary embolism can even cause mortality in all hospitalized patients, especially after trauma and lower extremity fracture, which further carries risk of significant morbidity and mortality. We aim to evaluate the epidemiological characteristics of postoperative DVT in tibial plateau fractures.Method: A prospective observational randomized study was performed. A total of 79 patient were included in this study who had proximal tibia fractures. Pre-op ultrasonography was done and post operative ultrasonography was done following proximal tibia plating surgery on day 2. Successive evaluation with USG was done at week 2, week 3 and week 4 for DVT. If DVT is diagnosed it will be managed medically.Result: A total of 79 patients were included in the study, 28 were females and 51 males. 4 out of 79 patients were diagnosed with DVT following surgery of tibial plateau fracture. Predominantly DVT was seen in male patient of elderly age group who had high energy trauma operated by open reduction with duration of surgery of more than 1 hour. 3 out of 4 patients had distal DVT and 1 had proximal DVT.Conclusions: Six risk factors were found to be strongly associated with DVT i.e., old age, male gender, high energy trauma, increased preoperative interval, open reduction and prolonged duration of surgery. These epidemiologic data will be helpful in individual assessment, risk categorisation and development of targeted prevention programs

Determination of various etiological factors for diagnosis of non traumatic scapulo costal syndrome

Background: Scapulocostal syndrome, also known as "snapping scapula," is an under-recognized problem involving overhead or throwing motion of the upper extremities. It is often described as a snapping or grinding sensation accompanied with pain as the scapula touches the chest wall and an audible or palpable click near the anteromedial scapula. Method: A prospective observational study was performed at one of the biggest tertiary care centres of central India from September 2021 to March 2023. A total of 50 patients were included in this study. Patient were evaluated clinically in OPD for pain in Scapulothoracic region. All the suspected patients underwent various investigations like X-ray, ultrasonography, electromyography, nerve conduction velocity study, magnetic resonance imaging (MRI) depending on the condition to reach a diagnosis. The data was recorded and evaluated. Results: A total of 50 patients were included in the study, 30 were females and 20 males, 50 % of our patients were diagnosed with supraspinatus tendinosis, 8 patients were found to have bicipital tendinitis, 3 patients had acromioclavicular joint arthritis, 2 patients developed pain because of glenohumeral joint arthropathy, subscapularis tendinitis. There were some other conditions as well diagnosed in few patients with the help of various investigations. Conclusions: It was found that there were various reasons for pain in patients diagnosed clinically with scapulocostal syndrome. Dominant hand affection was more common. The clinical investigations play a major role in diagnosing these conditions and planning the treatment

Radiographic evaluation of knee joint space width using fixed flexion view in knees of Indian adults

Background: The objective of this study is to evaluate the tibiofemoral joint space width in the medial and lateral compartments of the knee using digital radiograph. The measurement of knee joint space width (JSW), in between the femur and the tibia is a way of evaluating the tibio-femoral cartilage thickness. This study is aimed at establishing normal references of joint space width for use in diagnosis and follows up of knee cartilage diseases.Methods: This study is prospective and carried on 50 subjects at SAMC & PGI, Indore, M.P. One patient refused to sign the consent and was excluded. All subjects were healthy adults with sedentary lifestyle. All subjects underwent x-ray of bilateral knee joints. The joint space width of both medial and lateral compartments of each knee was measured using the scale in the computerized software.Results: The average age in the study group was 44.59 years with male preponderance.The mean left medial and lateral joint space width was 5.34 mm±1.26 mm and 5.21 mm±1.04 mm and on right side was 5.26±1.11 mm and 5.57±1.57 mm, respectively. No statistically significant difference was found between right and left knee joint space width compartments.Conclusions: The values obtained after observing the radiographic references showed no significant gender variation in knee joint space width. But, it is seen that there is a decrease in joint space width with increasing age, which progresses towards osteoarthritis of knee

Confounding variables affecting long term results of standard two screw cephalomedullary nail in intertrochanteric fractures of femur

Background: Inter trochanteric fractures of femur are common fractures in the elderly. The aim of the study was to assess the long-term functional outcome of patients treated with trochanteric fixation nail (TFN) for inter trochanteric femur fractures and to determine variables which affect the final outcome of surgery at the end of five years.Methods: The study was done at tertiary centre in central India with 152 patients who sustained intertrochanteric femur fracture. The patients were followed up at 6 weeks, 6 months, 1 year, 2 years and 5 years after the surgery. The assessment of pain, functional activity, walking ability and range of motion were assessed by Harris hip score at 6 months, 1 year, 2 years and 5 years.Results: The good/excellent outcome at the end of 5 years was found in 84% of cases. Patients with age less than 65 years and male patients had better outcome at the end of five years. Some of the complications encountered with this type of implant were z effect, delayed union, screw back-out/breakage, varus collapse which affected the final outcome.Conclusions: TFN is effective treatment technique for inter trochanteric fractures of femur worldwide. There are some complications which can occur with this type of implant in early post-operative period but still long-term follow-up of patients suggested that the fracture pattern, preoperative mobility status, timing of surgery, post op mobilization also plays a key role in determining functional outcome of patients

A comparative study of outcome of tension band wiring and hook plating in fracture olecranon

Background: Olecranon fractures are common upper limb fracture accounting for 40% of the fractures around elbow. Anatomic reduction and restoration of the joint surface is required for good outcome and to prevent post-traumatic arthritis. This study was directed towards the functional results and complications of surgical management of olecranon fracture treated with hook plate fixation and tension band wiring.   Methods: This prospective comparative study was done at a tertiary care centre from 2019 to 2022. This study consisted of 30 patients of fracture olecranon of which 15 were treated with tension band wiring and 15 with hook plate. All patients were followed up with minimum follow up of six months and evaluated for their functional outcome using Mayo elbow performance score. Results: In this study, the average age was 34 years in TBW group and 37 years in hook plate group. The mean Mayo elbow performance score after 6 months in TBW group was 88.33 (excellent) and in plate group was 90 (excellent). Superficial infection was present in 2 patients of the TBW group. Elbow stiffness was present in 2 patients of TBW group. Hardware impingement was present in one patient in each of TBW group and plate group. Conclusions: To achieve early movements and to prevent complications like traumatic arthritis and joint stiffness we need a perfect anatomical reduction in intra-articular fractures of the olecranon.  This study showed no significant difference in functional outcome with both the techniques, but the complications are more with TBW.

Evaluation of mobilization in operated case of fracture tibia

Background: In spite of all the advances optimal method of treatment, fractures of the tibia still pose a challenge to the orthopaedic surgeons and thus the management of the fractured tibia requires the widest experience, the greatest wisdom, and the nicest of the clinical judgement in order to choose the most appropriate treatment for particular pattern of injury. Therefore, in this study we evaluated the role of mobilization efficacy and results of nailing and plating compression in management of tibial fractures and its VAS scoring.Methods: This is a prospective study of fractures tibia in 150 cases aged from 18-60 years, out of which 109 (72.6%) were males. The left side was involved in 85(56.6%) patients and RTA was the major cause of the tibial fractures 98 (65.3%). Among the patients full weight bearing time was early (<3 weeks) with 90 (60%) and 60 (40%) patients within delay (>3 weeks) of surgery.Results: VAS score was significant better in early (<3 weeks) mobilization and in nailing treatment of tibial fractures in first month (7.8±074 and 7.6±0.81) and (2.1±0.8 and 1.8±0.65) at the final follow-up. Vas score correlation was significant with process and mobilization.Conclusions: We here conclude from our study that interlocking nailing appears to be promising method of treatment of unstable tibia fractures in adults without any external splintage after adequate stabilization and early weight bearing leading to excellent functional results in most of cases

Data Census of a Geographically-Bounded Tweet Set to Enhance Common Operational Picture Tools

Location information is of particular importance to crisis informatics. The Twitter API provides several methods to assess a rough location and/or the specific latitude and longitude in which a post originated. This paper offers a comparison of location information provided by Twitter’s four geolocation methods. The study aggregates one month of data from the greater Cincinnati, Ohio metropolitan area and assesses the relative contribution that each method can make to common operational picture tools used by crisis informatics researchers. Results show that of 49,744 Tweets, 4% contained geotags, 85.2% contained a location in the users’ profile, and 3.5% contained no apparent location data, but were gathered using the bounding box method and would not have been identified using traditional methods of gathering data using geotagged Tweets or user profile information alone. We reflect on these results in light of design implications for common operational picture tools (COPs)

Functional evaluation of various modalities of management in floating knee injuries at a tertiary care centre in central India

Background: The injuries involving femur and tibia fractures due to high velocity are known as floating knee injuries. These fractures may involve the shaft, metaphysis or the articular surface. There are many complications associated with these injuries. This study evaluates the functional, clinical and radiological outcomes of floating knee injuries. Methods: A Prospective and interventional study was performed at MGMMC and MYH Hospital, Indore. We included 30 patients in our study. Femur fractures are managed by intramedullary nailing or distal femur plating. Tibia fractures are managed by Intramedullary nailing or tibia plating. Patient were called for regular follow up for a minimum of 6 months. Functional and clinical evaluation done by Karlstorm and olerud scoring system and radiological outcome by union on x rays were done. Results: Out of 30 patients 28 (93.33%) male and 2 (6.66%) female. According to Fraser classification, 17 (56.66%) type 1, 4 (13.33%) type 2A, 4 (13.33%) type2B, 5 (16.66%) type 2C injuries. A majority of the injuries occurred due to road traffic accidents involving right limb 21 (70%) more then left 9 (30%). Knee stiffness occurred in 8, infection in femur 3, infection in tibia 2, malunion of femur 2, limb length discrepancy in 2 patients. Outcome was excellent in 5 (16.66%), Good in 10 (33.33%), Acceptable in 9 (30%) and poor in 6 (20%). Conclusions: Fraser type 1 fracture has excellent results and Fraser type 2C has poor results. Closed fracture has better outcome compared to compound Fractures. A better functional outcome can be determined on the basis of implant choice based on Fraser Classification, level of injury, open or closed injury, simple or compound type of fracture

Outcome analysis of vacuum assisted closure therapy in patients with open wounds

Background: Vacuum assisted Closure (VAC) of wound is a recent trend and proven method of fast and better healing of wounds. The basic concept is the removal of blood and serous collection from the wound site with negative pressure and promoting the healing process rapidly by altering the local microcellular environment.The objective of the study was to show the efficacy of healing process in open wounds treated by VAC method of dressing.Methods: In this prospective study, total of 50 patients with upper and lower limbs non-healing open wounds were recruited. Before the application of VAC, surgical debridement was performed to remove all the devitalized necrotic tissues and the wound was packed with povodine iodine. Prior to and at the end of VAC dressing, wound dimensions were noted.Results: Patients mean age was 46.72±7.63 years and out of which 42 patients (84%) were males and 8 patients (16%) were females. All patients had suffered an acute trauma. VAC therapy was applied through continuous or intermittent suction on wounds and dressing were changed every second or third day. After application of VAC therapy all wounds showed improvement, which were indicated by presence of healthy granulation tissue, absence of necrotic tissue and subsequent wound closure. Conclusions: VAC dressing in an open wound is an efficient and safe adjunct to treat severe infections and may be a good alternative to treat the open wounds in selected patients. Short time intervals between VAC changes and short course of therapy result in good patient acceptance. This method is recommended for all the types of non-healing wounds management