Management of complex intertrochanteric fractures of the femur in elderly patients – dynamic hip screws or proximal femoral nails or arthroplasty

Background: Ideal management of intertrochanteric fractures in elderly individuals has been debated for several years. Due to difficulty in obtaining anatomical reduction, management of the complex intertrochanteric fractures in elderly patients is challenging and controversial.Methods: In the present study prospective comparative evaluation has been done between dynamic hip screws (DHS), proximal femoral nail (PFN) and bipolar hemiarthroplasty for overall clinical outcome of patients with unstable intertrochanteric fractures. The total numbers of patients were 90 with each group consisted of 30 patients.Results: Complication rate and requirement of revision surgery was more in DHS group but this was not found to be statistically significant. Harris Hip Score & hence the functional outcome was found to be more in PFN group as compared to DHS which was statistically significant. Bipolar hemiarthroplasty provides early full wieght bearing leading to better HHS at 6 weeks evaluation but almost similar score to PFN in long term. Conclusions: PFN is better choice of fixation if good bone quality present while extremely osteoporotic patients or extreme comminution at fracture site favours bipolar hemiarthroplasty in elderly patients

Computed Tomography- and Radiography-Based Morphometric Analysis of the Lateral Mass of the Subaxial Cervical Spine in the Indian Population

Study DesignThis was a double-blinded cross-sectional study, which obtained no financial support for the research.PurposeTo obtain a detailed morphometry of the lateral mass of the subaxial cervical spine.Overview of LiteratureThe literature offers little data on the dimensions of the lateral mass of the subaxial cervical spine.MethodsWe assessed axial, sagittal, and coronal computed tomography (CT) cuts and anteroposterior and lateral X-rays of the lateral mass of the subaxial cervical spine of 104 patients (2,080 lateral masses) who presented to a tertiary care public hospital (King Edward Memorial Hospital, Mumbai) in a metropolitan city in India.ResultsFor a majority of the parameters, males and females significantly differed at all levels (p<0.05). Females consistently required higher (p<0.05) minimum lateral angulation and lateral angulation. While the minimum lateral angulation followed the order of C5<C4<C6<C3, the lateral angulation followed the order of C3<C5<C4<C6. The lateral mass becomes longer and narrower from C3 to C7. In axial cuts, the dimensions increased from C3 to C6. The sagittal cut thickness and diagonal length increased and the sagittal cut height decreased from C3 to C7. The sagittal cut height was consistently lower in the Indian population at all levels, especially at the C7 level, as compared with the Western population, thereby questioning the acceptance of a 3.5-mm lateral mass screw. A good correlation exists between X-ray- and CT-based assessments of the lateral mass.ConclusionsLarger lateral angulation is required for Indian patients, especially females. The screw length can be effectively calculated by analyzing the lateral X-ray. A CT scan should be reserved for specific indications, and a caution must be exercised while inserting C7 lateral mass screws

Evaluation of Spinal Fusion in Thoracic and Thoracolumbar Spine on Standard X-Rays: A New Grading System for Spinal Interbody Fusion

Study Design: Retrospective evaluation of prospectively collected data. Objective: Analyzing time course and stages of interbody fusion of a uniformly operated cohort, defining a grading system and establishing diagnosis-dependent periods of bone healing. Methods: Sequential lateral radiographs of 238 patients (313 levels) with interbody fusion operated thoracoscopically were analyzed. Results: Evaluation of 1696 radiographs with a mean follow-up of 65.19 months and average numbers of 5.42 (2-18) images per level was performed. Diagnoses were Pyogenic Spondylitis (74), Fracture (96), Ankylosing Spondylitis (38) and Degenerative Disease (105). No case with Grade 2 deteriorated to Grade 5. On average, Grade 4 persisted for 113 days, Grade 3 for 197 days, Grade 2 for 286 days and Grade 1 for 316 days. The first 95% of levels (“Green Zone”, ≤ Grade 2) fused at 1 year, the remaining 4% levels fused between 12 and 17 months (“Yellow Zone”) and the last 1% (“Red Zone”) fused after 510 days. Conclusion: Sequential lateral radiographs permit evaluation of interbody fusion. Grade 2 is the threshold point for fusion; once accomplished, failure is unlikely. If fusion (Grade 2,1 or 0) is not reached within 510 days, it should be regarded as failed. The 510-day-threshold could reduce the necessity of CT scanning for assessing fusion. </jats:sec

Evaluation of Spinal Fusion in Thoracic and Thoracolumbar Spine on Standard X-Rays: A New Grading System for Spinal Interbody Fusion

Abstract Study Design: Retrospective evaluation of prospectively collected data. Objective: Analyzing time course and stages of interbody fusion of a uniformly operated cohort, defining a grading system and establishing diagnosis-dependent periods of bone healing. Methods: Sequential lateral radiographs of 238 patients (313 levels) with interbody fusion operated thoracoscopically were analyzed. Results: Evaluation of 1696 radiographs with a mean follow-up of 65.19 months and average numbers of 5.42 (2-18) images per level was performed. Diagnoses were Pyogenic Spondylitis (74), Fracture (96), Ankylosing Spondylitis (38) and Degenerative Disease (105). No case with Grade 2 deteriorated to Grade 5. On average, Grade 4 persisted for 113 days, Grade 3 for 197 days, Grade 2 for 286 days and Grade 1 for 316 days. The first 95% of levels (“Green Zone”, ≤ Grade 2) fused at 1 year, the remaining 4% levels fused between 12 and 17 months (“Yellow Zone”) and the last 1% (“Red Zone”) fused after 510 days. Conclusion: Sequential lateral radiographs permit evaluation of interbody fusion. Grade 2 is the threshold point for fusion; once accomplished, failure is unlikely. If fusion (Grade 2,1 or 0) is not reached within 510 days, it should be regarded as failed. The 510-day-threshold could reduce the necessity of CT scanning for assessing fusion.ISSN:2192-5690ISSN:2192-568

Development and validation of HPTLC method to detect Curcumin and Gallic acid in polyherbal formulation

Curcumin and Gallic acid are one of the phytoconstituents present in Curcuma longa and Emblica officinalis, respectively. Both these plants are used traditionally in the treatment of cancer and for the treatment of leukemia. In the present study, an attempt has been made to develop a HPTLC method for quantitative estimation of curcumin and gallic acid in different anticancer polyherbal formulations. The method employed TLC aluminum plates precoated with silica gel 60 F-254 as the stationary phase. The solvent system consisted of chloroform: ethyl acetate: formic acid (7.5 mL\6mL\0.5 mL). This system was found to give compact spots for curcumin (Rf value of 0.55 +/- 0.02) and for gallic acid ( Rf value of 0.26 +/- 0.03). Densitometric analysis of curcumin and gallic acid were carried out in the absorbance mode at 254 nm. This HPTLC method was found to be reproducible, accurate, and can detect curcumin and gallic acid at a nanogram level. The developed HPTLC method would be an important tool in the quality control method for polyherbal formulations