Surgical management of fractures of distal end radius using uniplanar external fixator augmented with percutaneous kirschner wire fixation

Background: Distal end radius fractures is one of the most common fractures of the upper limb especially in the elderly population, accounting for about 17% of all upper limb fractures. Surgical stabilization of these fractures remains a challenge even today. Although the recent trend is towards internal fixation with locking plates, the external fixator itself has its own advantages in the treatment of these fractures.Methods: This study is a prospective, time bound, hospital based study conducted in Kempegowda Institute of Medical Sciences and Research Center, Bangalore, between November 2014 to April 2016. The study included 30 cases of distal end radius fractures that were operated with the closed reduction and uniplanar external fixator augmented with k-wire for distal end radius by the principle of ligamentotaxis.Results: In our study, 14 (46.6 %) patients had excellent results. Whereas, 11 (36.7%) patients had good results and 3 (10%) had fair and only 2 (6.7%) patients had poor results. Most of the fractures united by 12 weeks. Complications associated with the study was stiffness, malunion, sudeck’s  osteodystrophy and pin tract infection. Conclusions: The uniplanar external fixator augmented with k-wire is a good choice in the treatment of distal end radius fractures  in terms of providing a good functional outcome if proper preoperative planning, good reduction and surgical technique are followed, leading to high rate of bone union, minimal soft tissue damage and complications

Malignant transformation of a recurrent giant cell tumor of bone with lung metastasis: a case report

Giant cell tumors (GCT) are benign tumors with potential for aggressive behaviour and capacity to metastasize. It is a locally destructive tumor that occurs predominantly in long bones of adolescents and young adults in the epiphysis. Although rarely lethal, benign bone tumors may be associated with a substantial disturbance of the local bony architecture that can be particularly troublesome in peri-articular locations. It is characterized by a proliferation of mononuclear stromal cells and the presence of many multi-nucleated giant cells with homogenous distribution. There are varying surgical techniques ranging from intra-lesional curettage to wide resection. As most giant cell tumors are benign and are located near a joint in young adults, several authors favour an intralesional approach that preserves anatomy of bone. Although GCT is classified as a benign lesion, few patients develop progressive lung metastases with poor outcomes. Malignant transformation without radiotherapy exposure, is an uncommon event, occurring in less than 1% of giant cell tumors of bone. Here we reported a case of recurrent GCT of tibia that at the time of final recurrence was found to have undergone malignant transformation over a period of 6 years following several limb salvaging procedures. Concurrent metastases were found in the lung, but these were non-transformed GCT following which the patient has undergone above knee amputation

A comparative study between intraarticular infiltration of platelet rich plasma and hyaluronic acid in osteoarthritis knee

Background: Osteoarthritis (OA) is the most common progressive musculoskeletal condition that can affect joints, but it mainly affects the hips and knees as predominant weight-bearing joints and is characterized by structural modifications to primarily articular cartilage and subchondral bone, Hoffa’s fat pad, synovia, ligaments and muscles, leading to the concept of OA as a whole joint disease. Hence the present study was undertaken to evaluate the outcomes of platelet rich plasma (PRP) and hyaluronic acid (HA) intra-articular injections in patients with OA in terms of pain by numerical pain score and VAS and to evaluate the outcomes of PRP and HA intra-articular injections in patients with OA in terms of functional outcome by WOMAC scores. Methods: The study was a prospective hospital-based study in Kempegowda Institute of Medical Sciences between 2020 to 2022. The study was conducted on 100 patients, more than the age of 50 years of either gender with grade I-III OA of the knee fulfilling the inclusion and exclusion criteria. Patients were followed up at 6, 12 and 24 weeks for data collection and data was analyzed after follow-up visits were completed for all patients. Results: On intragroup analysis, there was significant reduction in the mean WOMAC score in both the study groups across time-points (p<0.05). On intragroup analysis, there was significant reduction in the mean VAS score in both the study groups across time-points (p<0.05). On intergroup analysis at any time point of follow-up, the mean WOMAC score was noted to be statistically comparable between the study groups (p>0.05). Conclusions: In patients with symptomatic knee OA, intra-articular HA and PRP provide short term improvement in pain and function. Both the therapy agents for OA were associated with equivalent safety, with no complications

The study of functional outcome in traumatic thoracolumbar spine fractures treated with Moss-Miami instrumentation

Thoraco lumbar fractures are grave injuries of utmost concern. If left untreated may result in marked morbidity and disability to the patient. Most of the polytrauma patients suffer from spine fractures which in turn can be associated with neurological deficits which makes the treatment of the spine fractures an important entity. Hence the present study was undertaken to study efficacy, evaluate the clinical and radiographic results, to study the advantages, complications and to facilitate early mobilization of patients and thus helping easy nursing care of the patients in order to recreate a stable, pain free spinal column by using Moss-Miami (pedicular screw). This prospective study was undertaken in the department of orthopaedics KIMS hospital and research centre, Bangalore, conducted on 20 patients fulfilling the inclusion and exclusion criteria. This study was undertaken from December 2020 to June 2022. Patients were followed up at 6, 12 and 24 weeks for data collection. The mean age of the study group was 45.7 years. The most common vertebrae involved in this series were between T11-L2 to the extent up to 65%. Among all the subjects 75% were able to return to previous employment with some restriction 75% had occasional minimal pain with no need for medication. The results of this study demonstrate the superiority of pedicle screw-rod instrumentation as a treatment for vertebral fracture with very high statistical significance in restoration of vertebral body height, mean regional angle, mean anterior wedge angle and considerable amount of neurological healing

Study of surgical management of fracture of proximal humerus by PHILOS plate and screws

Background: Proximal humerus fracture accounts for about 5% of all fractures in recent advances proximal humerus fractures are often managed operatively with PHILOS plate which provides greater angular stability and study was aimed at to assess functional outcome of PHILOS plate fixation in proximal humerus fractures.Methods: Prospective study of 31 cases of proximal humerus fractures admitted and operated in Kempegowda Institute of Medical Sciences Hospital November 2017 to May 2019 of which 4 patients died due to medical comorbidities so 27 patients were studied. Follow-up of these patients was done at 6 weeks, 12 weeks and 24 weeks with functional evaluation was done using Constant and Murley (CM) scoring and disabilities of the arm, shoulder and hand (DASH) scoring.Results: CM scoring and DASH scoring was applied to analyze the functional outcome among the cases. Most of the patients had excellent outcome (52%) followed by good (26%), fair (8%) and poor (15%) outcome according to CM scoring and according to DASH scoring 20.21 was mean score and mean CM score was 77.62. Complications observed were impingement in 1 patient, avascular necrosis in 2 patient and non union in 1 case.Conclusions: We conclude that the use of PHILOS plate for the fixation of proximal humerus fractures is a good device as it provides rigid fixation and early mobilisation and prevented complications. Precontoured locking plates work on the principle of angular stability, divergent screws, less disruption of vascularity and less chances of plate failure

Comparative study of fixation of intertrochanteric fracture of the femur by proximal femur nail versus dynamic hip screw

Background: Intertrochanteric fractures are common in old age group, but uncommon in younger age group. The goal of treatment of intertrochanteric fractures is restoration to pre-injury status at the earliest. The purpose of this study is to compare the functional outcome of the two fixation devices proximal femur nail (PFN) and dynamic hip screw available for intertrochanteric fractures in terms of the eventual functional outcome of the patient.Methods: Prospective study of 30 cases of Intertrochanteric fractures admitted and operated in KIMS hospital from November 2017 to May 2019. Follow-up of these patients was done at 6 weeks, 12 weeks and 24 weeks with functional evaluation was done using Harris hip score at the 24th week.Results: The results at the end of 24 weeks follow-up were calculated by the Harris hip score were better with the PFN. 66.7% of the patients operated with PFN gave excellent results as compared to 60% of patients operated with dynamic hip screw (DHS).Conclusions: We conclude that the use of PFN for the fixation of trochanteric fractures against the proven DHS offered better results along with a few advantages. PFN required smaller incision, shorter duration of surgery, less blood loss and faster recovery and better functional outcome at the end of 24 weeks. But still PFN is technically more demanding than the DHS and was found to have longer fluoroscopy exposure. 

Toward a Universal Structural and Energetic Model for Prokaryotic Promoters

With almost no consensus promoter sequence in prokaryotes, recruitment of RNA polymerase (RNAP) to precise transcriptional start sites (TSSs) has remained an unsolved puzzle. Uncovering the underlying mechanism is critical for understanding the principle of gene regulation. We attempted to search the hidden code in -16,500 promoters of 12 prokaryotes representing two kingdoms in their structure and energetics. Twenty-eight fundamental parameters of DNA structure including backbone angles, basepair axis, and interbasepair and intrabasepair parameters were used, and information was extracted from x-ray crystallography data. Three parameters (solvation energy, hydrogen-bond energy, and stacking energy) were selected for creating energetics profiles using in-house programs. DNA of promoter regions was found to be inherently designed to undergo a change in every parameter undertaken for the study, in all prokaryotes. The change starts from some distance upstream of TSSs and continues past some distance from TSS, hence giving a signature state to promoter regions. These signature states might be the universal hidden codes recognized by RNAP. This observation was reiterated when randomly selected promoter sequences (with little sequence conservation) were subjected to structure generation; all developed into very similar three-dimensional structures quite distinct from those of conventional B-DNA and coding sequences. Fine structural details at important motifs (viz. -11, -35, and -75 positions relative to TSS) of promoters reveal novel to our knowledge and pointed insights for RNAP interaction at these locations; it could be correlated with how some particular structural changes at the -11 region may allow insertion of RNAP amino acids in interbasepair space as well as facilitate the flipping out of bases from the DNA duplex