Role of viscosupplementation in the management of primary osteoarthritis knee

Background: Viscosupplementation is frequently used as a therapeutic strategy to manage patients with early osteo-arthritis of knees. A case series was followed up for a period of one year to study the clinical efficacy of intra-articular hyaluronic acid injections in different Kellegren Lawrence grades of osteoarthritis knee.Methods: 76 patients with primary osteoarthritis of knee not responding to analgesics, Quadriceps strengthening exercises, superficial and deep heat modalities were recruited after meeting inclusion criteria. They were followed up till the end of one year at an interval of every four months. Seventy patients completed the study and were analyzed for pain, stiffness and physical function using WOMAC osteoarthritis index. WOMAC scores were documented at initial consultation and follow up visits at the end of fourth, eighth and twelfth month.Results: Patients with Grade 1 and 2 osteoarthritis knee showed improvement in pain, stiffness and physical function following viscosupplementation lasting for one year. Those with Grade 3 osteoarthritis knee initially revealed good pain relief, enhanced function clinically till the second follow up. After that majority of the patients with Grade 3 osteoarthritis demanded for another session of viscosupplementation and expressed worsening of their knee symptoms. In Grade 4 osteoarthritis knee viscosupplementation found to be clinically and statistically ineffective. Adverse reactions following intra-articular hyaluronic acid injections included pain in five patients, pain and swelling in three patients, and injection site erythema in one patient.Conclusions: Viscosupplementation is a good therapeutic strategy in management of Grade 1-2 osteoarthritis knee. Intra-articular hyaluronic acid injections in Grade 3 osteoarthritis knee helps in delaying surgical intervention. It is in effective in Grade 4 osteoarthritis knee

Management of patella fractures with different modalities

Background: Patella fracture is quite a common injury for all ages of patients, constituting approximately 1% of all skeletal injuries. Patella is the largest sesamoid bone in the body. The aim of study was to assess the functional outcome of patella fractures treated with modified tension band wiring using K wires and cannulated cancellous screws with tension band construct.Methods: This study was a prospective clinical study to be conducted at the Department of Orthopaedic Surgery, Chalameda Anand Rao Institute of Medical Sciences, Karimnagar from October 2016 to November 2018. Total, 20 patients with transverse patellar fractures were studied and divided into 2 groups according to the surgical technique: 10 patients were in the MKTB group and 10 patients in the CSTB group.Results: Total 20 patella fractures were included in this study. The Bostman’s score of ROM, pain, atrophy of quadriceps femoris, and effusion were all higher in the CSTB group than in the MKTB group.Conclusions: We conclude that compared with the MKTB technique, CSTB fixation is an effective surgical procedure for treatment of displaced transverse patellar fractures

Effects of low intensity pulsed ultrasound to reduce the effusion volumes and pain with knee osteoarthritis: a randomized controlled trial

Background: The study aim was to determine the effect of low intensity pulsed ultrasound therapy to reduce the effusion volumes and pain in patients with Knee OA.Methods: This study design was randomized controlled trial. Total 50 patients diagnosed with Knee osteoarthritis were randomly assigned to two groups. Group I was using treatment of low intensity pulsed ultrasound therapy and group II was administered TENS with home exercise respectively. Treatments were 6 days per week and duration of 2 week. The amount of effusion volume will be measured via ultrasonograpy in knee.Results: The maximum number of cases are lying in age group >60 years which is 28% and 40% in cases and control group respectively and age distribution in both the group is statistically not significant. The mean age of patients in cases and control group is 57.08±7.40 years and 58.04±9.93 years respectively.Conclusions: Low intensity pulsed ultrasound therapy significantly reduced the effusion volumes and pain in patients with knee osteoarthritis

A Case of Neglected Bilateral Anterior Shoulder Dislocation: A Rare Entity with Unusual Mechanism of Injury

Bilateral shoulder dislocations are rare, and if they occurred, posterior type of dislocations is common. Bilateral anterior shoulder dislocations are very rare and occur due to trauma with unique mechanism of injury. We report a case of unreduced simultaneous bilateral anterior dislocations of shoulder without associated fractures in a forty-year-old man following a unique mechanism of injury; both hands of the patient were pulled from either side. To the best of our knowledge, this unusual mechanism of injury has not been reported in the literature

A Case of Neglected Bilateral Anterior Shoulder Dislocation: A Rare Entity with Unusual Mechanism of Injury

Bilateral shoulder dislocations are rare, and if they occurred, posterior type of dislocations is common. Bilateral anterior shoulder dislocations are very rare and occur due to trauma with unique mechanism of injury. We report a case of unreduced simultaneous bilateral anterior dislocations of shoulder without associated fractures in a forty-year-old man following a unique mechanism of injury; both hands of the patient were pulled from either side. To the best of our knowledge, this unusual mechanism of injury has not been reported in the literature