A comparative study of functional outcome between posterior lumbar fusion and posterior lumbar interbody fusion in spondylolisthesis

Background: Spondylolisthesis is condition in which one vertebra slips over other vertebra. This study has been done to compare the functional outcome and complications of two techniques: posterior lumbar fusion (intertransverse fusion) and posterior lumbar interbody fusion.Methods: Total 20 patients with spondylolisthesis admitted in a tertiary care centre in Rajasthan were allotted alternatively in posterior lumbar fusion (PLF) group and posterior lumbar interbody fusion (PLIF) group. In PLF, fusion was done by placing bone graft between transverse processes and around facets. In PLIF, fusion was bone by placing cage in between vertebral bodies.Results: 20 patients were included in our study with female predominance (65%). Mean age was 54.2 years (PLF=58.4 and PLIF=50.2). 70% patients have L4-L5 level spondylolisthesis. Average operative time was less in PLF group, which is statistically significant. Functional outcome was measured by using visual analogue scale (VAS) score and Japanese orthopedics association score (JOAS) at 3 weeks, 3 months and 6 months. There is a significant decrease between preoperative VAS and at 6 months, in both PLF and PLIF group. JOAS was significantly increased at 6 months in both PLF and PLIF group as compared to preoperative score. But difference in JOAS at 6 months is not significant between PLF and PLIF.Conclusions: Both PLF and PLIF are equally effective for spondylolisthesis. Both techniques have same satisfactory results. As PLIF is more invasive technique, more operative time and more complications are seen

Assessment of functional outcome of operative vs conservative management of displaced clavicle fractures

Background: clavicle fractures account for approximately 2.6% of all fractures. Middle third fractures account for 80% of all clavicle fractures. Historically, clavicle fractures have been treated mostly nonoperatively with clavicular brace, but due to increase rate of complications such as nonunion and malunion, clavicle fractures are now increasingly being treated surgically which results in lower rate of such complications, besides improved patient oriented outcome and early mobilization.Methods: Current study is a prospective and observational comparative study, conducted over 30 patients diagnosed with displaced clavicle fractures coming to the department of orthopaedics in a tertiary care hospital in South Rajashthan between January 2019 to June 2020. Patients were then allotted alternatively into two groups. Patients selected for conservative treatment were treated with the figure of eight clavicle brace and arm sling pouch. Patients selected for operative treatment were treated with plating. Functional outcomes were assessed using Constant and Murley score in every follow up at 3 month and 6 month; and fracture union was assessed by serial radiographs taken at sixth week, third month and sixth month.Results: Among 30 patients, 15 patients were treated conservatively and rest 15 patients were treated surgically with plating. Functional outcome at the end of third and sixth months of follow up were measured by using Constant Murley score and found significantly higher in operative group than conservative group.Conclusions: In our study, it was found that at the end of 6 month follow up, patients treated surgically with plating had better functional outcomes than conservatively treated patients as measured by Constant and Murley score. It was also seen that, the duration of union and the incidence of complications was less in the operative group as compared to the conservative group.

Arthroscopic anterior cruciate ligament reconstruction using single bundle hamstring tendon autograft

Background: The present study was designed to analyze the postoperative outcome of arthroscopic anterior cruciate ligament (ACL) reconstruction with anatomical single bundle hamstring tendons autograft fixed in femoral tunnel using endobutton and in the tibial tunnel using interference screws and reinforced by anterior half of peroneus longus tendon (AHPLT), wherever required.Methods: 39 patients of complete ACL tear underwent arthroscopic anatomical single bundle ACL reconstruction using quadrupled hamstring tendon autograft. It was ensured that the quadrupled graft had a length of at least 7 cm and thickness of at least 8 mm. If either of these requirements were not met, then the graft was supplemented by AHPLT. For functional assessment, international knee documentation committee (IKDC) knee score was taken and clinical tests for antero-posterior stability were done. In addition, the foot and ankle disability index (FADI) scores were used to evaluate the ankle donor site of the AHPLT.Results: The average graft diameter was 8.74 mm and average graft length was 9.12 cm. There was significant improvement in post op IKDC score when compared with pre op score. There was no antero-posterior instability seen in any of the patients during follow up. 10 patients required an additional graft augmentation with AHPLT. There was no complaint about weakness of the ankle joint after surgery.Conclusions: Arthroscopic ACL reconstruction with anatomical single bundle hamstring tendon autograft is an excellent treatment option for ACL deficient knees. It gives excellent functional outcome with minimal complications. Graft if small in diameter can be reinforced by AHPLT without any detrimental effect on ankle function

Functional outcome of comminuted upper metaphyseal tibial fracture treated with circular external fixators

Background: High speed motor vehicle accidents are on the rise over the past few years. These are responsible for most of the complex fractures of the tibial metaphysic. Proper treatment of these fractures is of paramount importance. The use of circular fixators for the definitive treatment of such fractures entails a minimally invasive technique of insertion that gives good fracture reduction and stability combined with minimal postoperative complications.Methods: This study was prospective and conducted over 22 patients diagnosed with upper comminuted metaphyseal tibial fracture treated with circular external fixator.Results: In this series, all 22 patients (100%) were male. Fourteen cases (64%) involved the left tibia and eight (36%) fractures were on right. The mean patient age was 49.5 years (range 26-75). Road traffic collisions accounted for most of the injuries (n=14), while fall from bike (n=8). In this study, using knee society score evaluation, excellent results (KSS>80) were seen in 8 patients (36.36%), good results (KSS 70-79) were seen in 10 patients (45.45%), fair (KSS 60-69) in 4 patient (18.18%) and poor (KSS< 60) in 0 patient (0%). Complication seen was pin tract infection in 2 patients (9.9%), which was managed by regular pin site dressings. Another complication was non-union in 1 patient (4.54%). No other complication was encountered.Conclusions: Circular external fixation is a promising modality for surgical treatment of comminuted upper metaphyseal tibial fractures. It allows satisfactory realignment of the fractured fragments and their stabilization, besides early mobilization of the joints and care of associated soft tissue injuries, without significant complications