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.

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

Evaluation of efficacy and safety of intraarticular injections of leucocyte poor platelet rich plasma in osteoarthritis knee patients

Background: The present study evaluates the safety and efficacy of intraarticular injections of leucocyte poor platelet rich plasma (LP-PRP) in osteoarthritis (OA) knee patients. Patients with early osteoarthritis (K-L grading 1 and 2)-clinically and radiologically and those who gave consent to participate in the study were injected with 2.4 ml per knee of LP-PRP over unilateral or bilateral knees at 0, 1, 2 and 6 months of LP-PRP injections. Methods: 100 patients with osteoarthritis knee pain were injected with LP-PRP at 0.1.2 months on OPD basis. LP-PRP was prepared in a centrifugation machine at 2000 RPM for 4 minutes and 2000 RPM for 10 minutes for two consecutive times and then injected into knee with a medial suprapatellar approach using 20/21 G needle. This was repeated at 1 and 2 months of follow-up. Assessment of efficacy in terms of pain relief was done on the basis of visual analog score (VAS) and clinical outcomes on the basis of knee injury and osteoarthritis outcome scores (KOOS) at 0, 1, 2, 6 months following injection of LP-PRP. Results: The mean VAS at pre-injection was 7.22±0.965 which reduced to 3.06±1.223 at post-injection follow-up at 6 months. The mean KOOS at pre injection was 33.4±7.51 which increased to 78.86±8.80 at post-injection follow-up at 6 months. Conclusions: LP-PRP has emerged as an intriguing therapy option for knee OA, and our study has shown that it is effective after 6 months