Role of distal femoral locking plate in management of distal femoral fracture: a prospective study

Background: Distal femoral fracture one of common surgical challenges for an orthopaedic surgeon. Distal femoral locking plate is a good implant to be used in this anatomical location. Aim of our study was to review functional outcome, union time and complications in distal femoral fracture treated with distal femoral locking plate.Methods: A prospective study was done during June 2012 to July 2016. Patients were included on the basis of inclusion and exclusion criteria. These patients were managed with distal femoral locking plate by close or open method. Pritchett rating system was used to assess functional outcome of patient.Results: Total 28 patient were enrolled in our study. There were 21 male and 7 female. The age range was from 21 to 68 years. Functional outcome was excellent in 14 patient, good in 7 Patient fair in 3 and poor 4. Conclusions: Distal femoral locking plate is a reliable implant for treatment of distal femoral fracture including osteoporotic fractures. Proper surgical technique is key to good result

A Method for Malicious Network Packet Detection based on Anomalous TTL Values

In the current digital age, a pervasive shift towards digitalization is evident in all aspects of life, encompassing entertainment, education, business, and more. Consequently, the demand for internet access has surged, paralleled therefore unfortunate escalation in cybercrimes. This study undertakes an exploration into the intrinsic nature of network packets, aiming to discern their potential for malice or legitimacy. In the internet, 32 intermediate nodes are encountered by a Network packet before it reaches its final host. Our findings suggest that the time-to-live (TTL) parameter in certain IP packets diverges from the initial TTL by more than 32 intermediary hops. It's likely that these packets are generated by specialized software. We anticipate that malicious IP packets exhibit unconventional TTL values, influenced by factors such as the source machine's operating system and protocols like TCP/ICMP/UDP, etc. To gauge the effectiveness and value of the proposed method, an experiment was conducted utilizing the SNORT NIDS system. Filtering rules based on signatures were formulated to thoroughly analyze the traffic. Real network data, along with DARPA and MACCDC 2012 datasets, were employed as inputs for the SNORT NIDS, and it has been observed that the suggested approach successfully detects the anomalous network packets

Dynamization of external fixator is single stage definitive procedure for open fractures both bone leg

Background: Open fracture both bone leg is a common fracture present in orthopaedic causality. Treatment consists of I. V. antibiotics, debridement and external fixator. Judicious selection of the patients on basis of Gustilio and Anderson classification leads to external fixator as a definitive and single stage procedure with dynamization. It reduces the risk of infection at time of definitive procedure and number of hospital stay and surgery.Methods: In school of medical sciences and research, We treated 68 patients with open both bone fracture (Gustilio and Anderson type 2 and 3b) with debridement and external fixator. All patients underwent dynamization depending upon fracture pattern. Majority of our cases were road traffic accident involving male. Average duration of union was 22 to 26 weeks. There was no need for any major plastic surgery procedure. Removal of external fixator and Patellar tendon brace (PTB) was given for the period of 4 to 6 weeks at the time of clinical and radiological union.Results: Eighty eight percent of our cases united well. This reduces the burden of secondary definitive procedure, infection and cost of treatment. So careful selection of the patients and dynamization of external fixator hold the place for definitive surgical option for open both bone fractures.Conclusions: External fixator is simple effective surgical procedure for open fractures both bone leg. Staged dynamization of external fixator add in the better union with functional outcome and cost effective.

Improved rehabilitation and functional outcome with dedicated joint irrigation at the end of ACL reconstruction

Background: ACL is most common ligament injured during sports. Postoperative pain and swelling is one of the major limiting factors for the rehabilitation of ACL reconstructed patients. Cryotherapy and intra-articular bupivacaine injection are few measures to reduce the pain. One of the main reason for pain is inflammatory mediators, by joint irrigation it reduce the inflammatory mediator that reduce pain and swelling.Methods: We treated 33 patients of ACL injury with arthroscopic ACL reconstruction from July 2015 to April 2017. Postoperative pain and swellings were assed with VAS and suprapatellar fullness. VAS assessment done on 1st day, 2nd day and 12th day and for swelling 2nd day and 12th day. We had used closed loop endobutton for femur and bioscrew for tibia. In twenty patients at the end of the surgery we used 2 liter saline for joint irrigation.Results: As a result of wash of pro inflammatory mediators and debris, there were reduced inflammation which reduces pain and swelling. Patients who received irrigation had less VAS score and suprapatellar fullness than the other group. There was better knee flexion on 12th day.Conclusions: Adding up a dedicated joint irrigation at the end of surgery does not deviate from standard surgical protocol. No studies have stress upon joint irrigation. It reduce the pain and swelling by reducing inflammation which gives better result.

Association of aLDFA with functional outcome of distal femur fracture treated with locking plate

Background: Distal femoral fracture is one of the common presentations in orthopaedic emergency. Stable fixation and early mobilization is necessary to avoid knee stiffness with maximum functional outcome. We have done a retrospective analysis of Type 33A (supracondylar) and type 33C (supraintercondylar) fracture with distal femoral locking plate. Close observation done by aLDFA for varus collapse and functional outcome.Methods: 61 patients of Type 33A (supracondylar) and Type 33C (supraintercondylar) treated from January 2011 to august 2016 selected for the study. Functional and radiological outcome of fracture assed by mize criteria and aLDFA respectively. Most of the cases of Type 33C shows some amount of varus collapse specially type 33C3.Results: 6 out of 8 patients treated with type 33C3 treated with isolated distal femoral locking plate showed varus collapse more than 10 associated with implant failure and non union.Conclusions: Type 33C3 subset required a special consideration like dual plating or cortical strut graft on first go. aLDFA is strong predictor of for functional and radiological outcome

Diagnostic accuracy of an integrated approach using conventional ultrasonography, and Doppler and strain elastography in the evaluation of superficial soft tissue lesions

Introduction: To assess the diagnostic accuracy of an integrated approach using conventional ultrasonography, colour Doppler ultrasonography, and elastography strain ratios in tandem in the evaluation of superficial soft tissue lesions. Material and methods: Sixty-five subjects were included in this prospective cross-sectional study. Greyscale features and Doppler parameters were recorded. Strain elastography of the non-vascular and non-cystic lesions was performed and strain ratios were calculated. Fine-needle aspiration or biopsy of all the lesions was performed depending on their site and condition. Inter-rater k agreement was used to determine the strength of agreement between imaging-based diagnosis and histopathological diagnosis. A diagnostic test was used to calculate the sensitivity, specificity, positive predictive value, and negative predictive value. A p value of < 0.05 was considered statistically significant. Results: Multiple superficial soft tissue lesions were studied, the majority of which were lipomas, vascular anomalies, and epidermoid cysts. The diagnostic accuracy was very high and varied from 92.31% to 100% for various masses. The imaging-based diagnosis was in agreement with the histopathological diagnosis in 86.15% (n = 56) and disagreement in 13.85% (n = 9) of the cases (p < 0.007). There was very good inter-rater agreement between the imaging-based diagnosis and histopathological diagnosis (κ = 0.818). Conclusions: The combined use of conventional ultrasonography, colour Doppler, and elastography strain ratios provides a very effective non-invasive tool for the diagnosis of superficial soft tissue lesions and may negate the need for unnecessary biopsies. The advantage of this integrated approach using various ultrasound techniques needs no further emphasis

Fracture union in percutaneous Kirschner wire fixation in paediatric tibial shaft fractures

Purpose: To evaluate the efficacy of intramedullary Kirschner wires for the treatment of unstable tibial shaft fractures in children. Methods: This prospective study was conducted at the Department of Orthopaedic Surgery in Maharishi Markandeshwar Medical College from June 2005 to June 2010. Sixty-six children having closed fracture of the tibial shaft with a mean age of 7.7 years (range, 2–14 years) were recruited from emergency and outpatient department. They were treated with percutaneous intramedullary Kirschner wires. The clinical results of our study were rated on the basis of the criteria of union, nonunion, delayed union or malunion. All children were followed for one year. Results: Children achieved union in a mean time of 8 weeks (range, 6–10 weeks). Postoperatively, three children (4.55%) had delayed union, one (1.52%) valgus deformity of lower leg, three (4.55%) postoperative knee pain and twelve (18.18%) skin irritation at pin site. Wires were removed after 8–22 weeks without any complications. No patient was lost to follow-up. The results were excellent in 95.45% and good in 4.55% children. Conclusion: This technique is cost-effective, simple, quick to perform, safe and reliable and avoids prolonged hospitalization with good results

Fracture Union in Closed Interlocking Nail in Humeral Shaft Fractures

Background: Fracture shaft humerus is a major cause of morbidity in patients with upper extremity injuries. The aim of this study was to evaluate the outcome of interlocking nail in humeral shaft fractures. Methods: This study was conducted in the Department of Orthopedic Surgery in SMS and R Sharda University from January 2010 to November 2013. Seventy-eight patients were recruited from emergency and out-patient department having a close fracture of humerus shaft. All patients were operated under general anesthesia and closed reamed interlocking nailing was done. All patients were followed for 9 months. Results: Out of 78 patients, 69 patients underwent union in 90-150 days with a mean of 110.68 days. Complications found in four patients who had nonunion, and five patients had delayed union, which was treated with bone grafting. All the patients were assessed clinically and radiologically for fracture healing, joint movements and implant failure. The results were excellent in 88.46% and good in 6.41% patients. Complete subjective, functional, and clinical recovery had occurred in almost 100% of the patients. Conclusions: The results of the present study indicates that in the presence of proper indications, reamed antegrade intramedullary interlocked nailing appears to be a method of choice for internal fixation of osteoporotic and pathologic fractures