Functional outcome of patients undergoing open rotator cuff repair

Background: Rotator cuff tears are a common source of shoulder pain. The incidence of rotator cuff damage increases with age and is most frequently due to degeneration of the tendon rather than injury from sports or trauma. Rotator cuff tear can be treated arthroscopically, arthroscopically assisted (mini-open) or by an open procedure. Because of the technical demands of arthroscopic repair many surgeons consider open repair for the treatment of rotator cuff tears. This study was done to evaluate the functional outcome of shoulder after open rotator cuff repair.Methods: 26 patients with partial and complete rotator cuff tears underwent open rotator cuff repair and acromioplasty. Cases were followed up at 3 months and 6 months intervals and shoulder function was assessed using Constant-Murley scoring system and compared with the preoperative scores and analyzed using SPSS software.Results: Mean preoperative constant score was 33.95±7.545 while the mean constant score at 6 months post-surgery was 79.83±8.51 which was highly significant according to paired t test. The difference between preoperative, 3 months and 6 months constant scores of complete and partial tear patients was found to be statistically significant.Conclusions: There was highly significant increase in Constant-Murley score after 6 months in patients treated by open rotator cuff repair. Open repair still stands as an effective treatment for rotator cuff tears and doing acromioplasty during the procedure adds to better outcome after surgery

Outcome analysis of surgical management of type 2, 3a and 3b open fractures of distal 2/3rd tibial diaphysis using external fixators

Background: There is confusion regarding ideal fixation method for intermediate grades of open fractures of tibia. In distal 2/3rd of tibia the blood supply is precarious and so it further increases the confusion. Purpose of this study is to evaluate effectiveness of external fixator as definitive treatment in these fractures.Methods: 55 patients with type2, 3A or 3B open fractures of distal 2/3rd tibia were studied. External fixator applied at the time of debridement is removed and cast applied once wound is healed. Follow up at 1, 3, 6 and 9 months recorded. Union assessed using rust scoring system. Functional outcome assessed using Modified Functional Evaluation System by Karlstrom- Olerud after patients are mobilized.Results: Union rate was 74.5%.Functional outcome was satisfactory in 34%, moderate function in 32% and good function in 24.4%. In 7.3% the function was poor. Only one case gave excellent function.Among diabetic patients 71.4% developed wound infection and all developed pin tract infection showing strong association between diabetes and infection.Conclusion: Though external fixation followed by serial casting technique gave fare outcomes, there is scope for better results and so the option of other methods of treatment should not be excluded. There is a significant association between diabetes and infection and so special care and covigilance is advised in diabetic patients