Outcome of fractures of dorso lumbar spine treated by short segment posterior stabilization with intermediate pedicle screws

Background: Spine fractures are common in today’s world due to high frequency of motor vehicle accidents and work place injuries. These are major cause of disability in adult population. The mortality rate following spinal injuries is 7%. The aim of the study was to study the functional and radiological outcome of fractures of dorso lumbar spine treated by short segment posterior stabilization with intermediate pedicle screws.Methods: Dorso-lumbar fractures with intact pedicle on the fractured segment, Load sharing classification score of equal or less than 6, Neurologic involvement caused by the fracture, loss of vertebral body height by more than 50% and kyphosis angle more than 20° are included. Patients with multiple level fractures and pathological fractures were excluded from the study. Denis classification and AO classification were used. Load sharing score is used to decision making for intermediate screw fixation.Results: L1 is more frequently fractured followed by D12. Distraction type (AO) and burst (Denis) are most common types. 4 of our patients had complete neurological deficit. 15 had incomplete deficit and 11 patients doesn’t have any neurological involvement. Frankel A grade cases remained in the same grade. Mean Kyphotic correction is 6.7°. Mean AVBCP in the postoperative cases 26. None of the cases developed kyphosis or loss of correction in the follow up. Outcome using Roland Morris disability questionnaire is excellent in 64.3%, good in 21.6% and poor in 14.3% cases.Conclusions: To conclude that short segment posterior stabilisation with intermediate screws provides better biomechanical stability when compared with conventional short segment fixation

siRNA knockdown of SPHK1 in vivo protects mice from systemic, type-I Allergy.

Systemic anaphylaxis is considered to be a typical immediate hypersensitivity response, determined by the activation of immune cells,
via antigen-induced aggregation of IgE-sensitized FcεRI cells. Perhaps most the important cells, in the immediate hypersensitivity responses, are mast cells. We have previously shown that SPHK1 plays a key role in the intracellular signaling pathways triggered by FceRI aggregation on human
mast cells. More recently, we performed a genome-wide gene expression profiling of human mast cells, sensitized with IgE alone, or stimulated by FcεRI aggregation. We found that sphingosine kinase 1 (SPHK1) was one
of genes activated at the earlier stages of mast cell activation, including during sensitization. Moreover, SPHK1 has been shown, by us and others, to be a key player in the intracellular signaling pathways triggered by
several immune-receptors, including fMLP, C5a, and Fcg- and Fcereceptors. Here we have investigated the in vivo role of SPHK1 in allergy, using a specific siRNA to knockdown SPHK1 in vivo. Our results support a role for
SPHK1 in the inflammatory responses that share clinical, immunological, and histological features of type I hypersensitivity. Thus, mice pretreated with the siRNA for SPHK1 were protected from the IgE mediated allergic
reactions including: temperature changes, histamine release, cytokine production, cell-adhesion molecule expression, and immune cell infiltration into the lungs

A study on functional and radiological outcome of complex tibial plateau fractures by posteromedial plating

Background: In orthopaedic practice, three column concept and fixation for proximal tibia are becoming popular as it was proved that fixation of posterior column is a must for proper weight transmission and stability. This study demonstrates the use of the posteromedial surgical approach to the knee in treating patients with complex tibial plateau injuries with a posteromedial column fracture. The aim of the study was to study the functional and radiological outcome of complex tibial plateau fracture by posteromedial plating.Methods: This is a prospective study involving 20 patients with complex tibial condyle fractures with posterior column fractures. Preoperative computed tomography is taken with radiography for complete evaluation of fracture fragments even in the coronal plane. Fractures were classified as Schatzker type 4 or above with a posteromedial split depression. Plating is done with posteromedial locking compression for buttressing posteromedial fragment. The outcome of surgery was evaluated using the Oxford knee scoring system. Longest follow up of study is 2 years.Results: All fractures healed within 6 months without any secondary displacements or secondary osteoarthritis. Out of 20 patients 16 patients have the postoperative anatomic reduction (0 mm step off) 2 had an acceptable reduction of <2 mm step off. At 4-12 months median range of flexion 135*(125-145*). The mean Oxford knee score was 25-33.Conclusions: Fixation of posteromedial fragment in a complex tibial condyle fracture is a must as it involves posterior column. Using a locking compression plate provides perfect fracture fixation and thereby more stability to knee joint & better functional outcome