Assessing the factors that influence a recurrence of congenital talipes equinovarus in children treated with the Ponseti method

Background: Congenital talipes equinovarus, also known as clubfoot, is one of the most common congenital malformations in pediatric orthopedics. With a checkered treatment history extending from Hippocrates' bandages to Kite's serial plaster cast application to surgical treatment, no single modality can claim to be a complete treatment. Methods: In a combined prospective and retrospective study at the Department of Orthopaedics of St. Stephen's Hospital, 192 patients with 292 clubfeet who met the inclusion criteria and received ethics committee approval were included. The purpose of the research was to identify early recurrence characteristics, undertake the Pirani scoring, and identify additional clinical characteristics to evaluate recurrence predictors. Results: In our study, out of 192 patients, 188 were successfully treated with the Ponseti casting technique combined with tendoachilles tenotomy; tenotomy was required in 177 patients (93%). Four patients were lost to follow-up. Nine out of sixty-one children in the six-month-to-one-year age group showed the maximum rate of recurrence (15%). The mean number of cast applications was 7.23. In all, 90% of children required casts ranging from four to eight in number. The syndromic association was seen in 10.4% of cases with club feet. Most common among them were neural tube defects (4.2%) and arthrogryposis (3% of cases). Fourteen out of 154 (or 9%) of the non-operated idiopathic patients had lateral border recurrence during an average follow-up of two years. According to the Pirani score, recurrence was seen in eight out of twenty (or 40% of) syndromic patients and five out of fourteen (or 35% of) operated cases. In 37% of recurrences, dynamic supination was observed. Conclusions: Even though Ponseti's approach to treating idiopathic clubfoot is widely regarded as the gold standard, recurrences are known to occur even in the best of circumstances. The most common cause of recurrence was poor brace compliance, with families citing a variety of reasons

Investigating the effectiveness of anterolateral distal tibia plate in treating distal tibial fractures in adults: a prospective study

Background: “Pilon” fractures of the distal tibia are a term used usually by orthopaedic surgeons. High-energy trauma and related soft tissue injuries are the main causes. It might be challenging to treat distal one-third of tibial fractures that affect the articular process or not. The objective of this work is to analyze the result of the Anterolateral Distal Tibia Plate in distal tibial fracture treatment in adults. Methods: After receiving permission from the ethical committee, this prospective interventional analysis was conducted among 25 patients who satisfied the inclusion standards and were given anterolateral distal tibia plates. The scoring system created by “Ovadia and Beals” was used to evaluate patients at the conclusion of the follow-up period. Results: The participants in this research varied in age from 18 to 64, with a mean age of 36. 13 patients had a left tibia fracture and 12 patients had a right tibia distal end fracture. There were 4 open GA-I fractures and 21 closed GA-I fractures. 18 patients got fractures as a result of road traffic accidents (“high energy trauma”), and 7 patients sustained a fracture due to a fall (low energy trauma). The union of fracture occurred in 24(96%) patients and 1(4%) case showed delayed union. The average period of union was 18 weeks with the radiological signs of callus formation. 2 patients developed superficial and 1 patient developed deep infection. Conclusions: Distal end tibial fractures especially with intra-articular involvement may be effectively treated by anterolateral plating within a single stage, offers advantages such as adequate fracture exposure, soft tissue preservation, and reliable fracture healing

An alternative osteosynthesis technique: single column anatomical plate fixation for distal humerus diaphyseal fractures

Background: The treatment of distal humerus diaphyseal fractures presents significant challenges for orthopedic surgeons. The goal of this study is to evaluate the effectiveness and outcomes of a single column anatomical plate as an alternative method of osteosynthesis for fixing distal humerus diaphyseal fractures. Methods: A Prospective analysis of patients who underwent surgery for distal humerus diaphyseal fractures at a tertiary care medical center was conducted. Patients who received treatment using a single column anatomical plate were included in the study. Preoperative, intraoperative, and postoperative data, including fracture type, surgical approach, complications, range of motion, and radiographic outcomes, were collected and analyzed. Results: Type B2 fractures were more common in our study i.e., 80%. The maximum incidence was between 18 to 59 years i.e., 21 cases (77%). Average radiological union was seen at 15 weeks. This study shows Excellent outcome in 67% and Good in 30% of patients. Average post-operative ROM at 1 year was mean flexion 120°(SD 7), mean extension of 6 degrees (SD 4.7), mean pronation 81.25°(SD 2.5) and mean supination 82.5°(2.8). Average MEPS score was 95.5 at 1 year. The mean metaphyseal-diaphyseal angle was 85°, the mean humeral-ulnar angle was 14°, which was within the normal limits. Conclusion: The use of a single column anatomical plate for fixing distal humerus diaphyseal fractures appears to be a promising alternative method of osteosynthesis. However, further prospective studies with larger sample sizes and longer follow-up periods are warranted to validate the efficacy and safety of this technique

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Thromboprophylaxis in Proximal Femur Fracture: A Pilot Survey among Practicing Orthopaedic Surgeons in India

Introduction: Venous Thromboembolism (VTE) and Pulmonary Embolism (PE) are more common following orthopaedic surgeries around the hip than other surgeries. However, there is still a dilemma among orthopaedic surgeons regarding whether routine thromboprophylaxis is justified in patients. Aim: To describe current practices among orthopaedic surgeons regarding routine thromboprophylaxis among patients with proximal femur fractures. Materials and Methods: A cross-sectional exploratory study was conducted at Department of Orthopaedics, Saveetha Medical College, Chennai, Tamil Nadu, India between March 2022 and May 2022 among orthopaedic surgeons. A Google survey form, containing 10 prevalidated multiple-choice questions, was shared on social media and medical groups. Descriptive analysis was undertaken, and statistical analysis was done with International Business Machines (IBM) Statistical Package for Social Sciences (SPSS) software version 28.0. Results: Among the 141 respondents, 72% were from private sector institutions/hospitals. Over 90.78% of the respondents indicated that there was a role for anticoagulation therapy in proximal femur fractures, and 92% used low molecular weight heparin. The responses varied slightly depending on whether anticoagulant treatment was used preoperatively (51%) or postoperatively (48%), and if there was a waiting time of less than 24 hours to 3-5 days before surgery. Most orthopaedic surgeons opted for anticoagulation therapy in the presence of a previous history of Deep Vein Thrombosis (DVT)/PE (79%), age greater than 70 years (61%), and use of hormone replacement therapy (64%), or if the surgery lasted more than two hours (61%). Conclusion: The present study concludes that 9.2% of orthopaedic surgeons do not use anticoagulation therapy and nearly half (48%) do not administer anticoagulation therapy preoperatively. As the proportion of elderly patients increases, consensus building will enable the formulation of practice guidelines based on evidence generated through such surveys

Comparative Analysis of the Antioxidant, Antidiabetic, Antibacterial, Cytoprotective Potential and Metabolite Profile of Two Endophytic <i>Penicillium</i> spp.

The current study assessed the metabolite abundance, alpha (α)-amylase and α-glucosidase inhibitory, antioxidant, and antibacterial activity of the ethyl acetate extract (EAE) of endophytic Penicillium lanosum (PL) and Penicillium radiatolobatum (PR). A higher extract yield was found in EAE-PR with a total phenolic content of 119.87 ± 3.74 mg of GAE/g DW and a total flavonoid content of 16.26 ± 1.95 mg of QE/g DW. The EAE-PR inhibited α-amylase and scavenged ABTS+ radicals with a half-maximal inhibitory concentration (IC50) of 362.5 and 37.5 µg/mL, respectively. Compared with EAE-PL, EAE-PR exhibited higher antibacterial activity against Gram-positive and Gram-negative pathogens. Treatment with EAE-PR (1000 µg/mL) did not cause significant toxicity in the HEK-293 cell line compared to the control cells (p 2O2-stressed HEK-293 cells compared with ascorbic acid (AA). The UHPLC-Q-TOF-MS/MS analysis revealed the presence of thiophene A (C13H8S), limonene (C10H16), and phenylacetic acid (C8H8O2) in EAE-PR. Furthermore, these compounds demonstrated substantial interactions with diabetes (α-amylase and α-glucosidase), oxidative stress (NADPH-oxidase), and bacteria (D-alanine D-alanine ligase)-related enzymes/proteins evidenced in silico molecular docking analysis

Antioxidant and Antibacterial Effects of Potential Probiotics Isolated from Korean Fermented Foods

A total of sixteen bacterial strains were isolated and identified from the fourteen types of Korean fermented foods that were evaluated for their in vitro probiotic potentials. The results showed the highest survivability for Bacillus sp. compared to Lactobacillus sp. in simulated gastric pH, and it was found to be maximum for B. inaquosorum KNUAS016 (8.25 &plusmn; 0.08 log10 CFU/mL) and minimum for L. sakei KNUAS019 (0.8 &plusmn; 0.02 log10 CFU/mL) at 3 h of incubation. Furthermore, B. inaquosorum KNUAS016 and L. brevis KNUAS017 also had the highest survival rates of 6.86 &plusmn; 0.02 and 5.37 &plusmn; 0.01 log10 CFU/mL, respectively, in a simulated intestinal fluid condition at 4 h of incubation. The percentage of autoaggregation at 6 h for L. sakei KNUAS019 (66.55 &plusmn; 0.33%), B. tequilensis KNUAS015 (64.56 &plusmn; 0.14%), and B. inaquosorum KNUAS016 (61.63 &plusmn; 0.19%) was &gt;60%, whereas it was lower for L. brevis KNUAS017 (29.98 &plusmn; 0.09%). Additionally, B. subtilis KNUAS003 showed higher coaggregation at 63.84 &plusmn; 0.19% while B. proteolyticus KNUAS001 found at 30.02 &plusmn; 0.33%. Among them, Lactobacillus sp. showed the best non-hemolytic activity. The highest DPPH and ABTS radical scavenging activity was observed in L. sakei KNUAS019 (58.25% and 71.88%). The cell-free supernatant of Lactobacillus sp. considerably inhibited pathogenic growth, while the cell-free supernatant of Bacillus sp. was moderately inhibited when incubated for 24 h. However, the overall results found that B. subtilis KNUAS003, B. proteolyticus KNUAS012, L. brevis KNUAS017, L. graminis KNUAS018, and L. sakei KNUAS019 were recognized as potential probiotics through different functional and toxicity assessments

Management of Intra-Articular Distal Radius Fractures by Open Reduction Internal Fixation and Plate Osteosynthesis Vs Ligamentotaxis : A Comparative Study

AIM: To analyze and compare the functional and radiological outcome of different methods of surgical management of intra-articular distal radius fractures in 50 patients treated by either open reduction, internal fixation and plate osteosynthesis using distal radius volar locking plate or by closed reduction and ligamentotaxis using external fixator with the addition of k wires.&nbsp;MATERIALS AND METHODS: This prospective interventional study was conducted among 50 patients with distal radius intra-articular fracture, treated by either&nbsp; open reduction internal fixation and plate osteosynthesis using distal radius volar locking plate or by closed reduction and ligamentotaxis using external fixator with the addition of k wires if needed in our institute between July 2020 and November 2022 over a period of 2 years and 5 months.&nbsp;RESULTS: In our study, there were 43 male and 7 female patients, most of whom were in the age group 30-50 years (48%). The mode of injury in most cases was RTA (Road traffic accident).Out of 50 patients, 25 were treated by Open reduction, internal fixation with Volar locking compression plate and 24 were treated by Closed reduction and external fixation augmented by K wire fixation (Ligamentotaxis). There was also found to be no significant difference in the radiological outcome in both groups of patients, i.e Radial length (p=0.253), Palmar tilt (p=0.08), Radial inclination (p=0.075) and articular step-off (p=0.207). In terms of functional outcome of both procedures, only significant difference was found to in palmar flexion of the wrist joint (p=0.003) with better range of palmar flexion seen in the Open reduction and internal fixation with volar locking compression plate group. There was no significant difference seen in dorsiflexion, ulnar and radial deviation, supination and pronation between both surgical techniques. We had a few complications such as malunion, pin loosening and wrist stiffness in our study, majority of which was seen in the Ligamentotaxis group, but it had no statistical significance. A mean DASH score of 11.788 was seen in the VLCP group and 15.192 was seen in the Ligamentotaxis group, the difference was not statistically significant