Ankylosing Spondylitis and Other Seronegative Arthritis

Spondyloarthropathies are a group of disorders having some common features. They are characterised by inflammation of the attachment of tendons known as enthesitis. They are common in males. There is a familial occurrence. There is an association with HLA-B 27. Rheumatoid factor will be negative. Axial skeleton involvement in the form of sacroiliitis or spondylitis is common. The common conditions include ankylosing spondylitis, Reiter’s disease, psoriatic arthritis, enteropathic arthritis and reactive arthritis. In this chapter we are going to describe the clinical features, evaluation and management of common spondyloarthropathies

Clinical and Radiological Assessment of Acetabular Fracture

Acetabular fractures are one of the rare injuries. They are usually occurring following a high energy trauma. The type of acetabular fractures is mainly depend on the position of the femoral head at the time of injury. The acetabular fracture are usually associated with visceral and neurovascular injuries. There can be anterior, posterior or central fracture dislocation associated with this injury. A closed degloving injury of the subcutaneous tissue which is detached from the underlying fascia-Morel-Lavelle lesion is also common feature. The sciatic nerve injury can be associated with posterior wall or column injuries. The most commonly used investigation are anteroposterior, Judet views and 2D/3D computerized tomography. Most commonly used classification is modified Judet and Letournel classification. They divided acetabular fractures into five simple fracture patterns and five associated fracture pattern. The Orthopedic trauma association modified Letournel classification and gave computerized coding. In this chapter, we are describing the clinical features and classification of acetabular fracture in a simple and vivid manner

The prevalence of femoroacetabular impingement in asymptomatic hips in Indian population: a radiomorphometric analysis

Background: Femoroacetabular impingement (FAI) is a common cause of secondary osteoarthritis of the hip. There are no much studies about the occurrence of FAI in asymptomatic individuals in Indian population. Our objective was to find out the radiological prevalence of FAI in asymptomatic adult Indian population.Methods: A cross sectional study was carried out in our institution, which is a tertiary care centre, between September 2016 and September 2018 in which in which we studied radiographs of 1600 hips from 800 pelvic x-rays of asymptomatic patients.Results: Out of 1600 radiographs of the hips studied 1353 were found to be normal and the remaining 247(15.4%), had features of FAI. 61 hip radiographs (3.8%) showed cam lesions and 9.2 % showed pincer type of lesion.38 hips (2.4%) showed mixed type of FAI.Conclusions: Significant number of radiographs of asymptomatic patients showed features of FAI. Further long-term studies are needed to see the proportion of these patients with FAI progressing to secondary osteoarthritis of hip

Acute Compartment Syndrome of the Extremities and Paraspinal Muscles

Acute compartment syndrome (ACS) occurs when the pressure within the closed osteo-fascial compartment raises above perfusion pressure leading to irreversible tissue ischemia and necrosis. Any closed compartment in the body can be affected by ACS. The leg is the commonest site. Trauma is the common cause of compartment syndrome in young patients. In older patients, medical causes can cause it. The diagnosis in a conscious patient can be made based on clinical features. Pain out of proportion to the injury is the most important symptom. Exacerbation of pain on stretching the affected muscles and paresthesia are the common signs. Compartment pressure measurement is important for the diagnosis in unconscious and uncooperative patients. The treatment of established ACS is emergency fasciotomy. Untreated compartment syndrome can lead to neurovascular injuries and muscle contractures. In this chapter, we will see the etiologies, clinical features, investigations, and management of acute compartment syndrome of the extremities and the paraspinal region

The outcomes of mobilization under continuous interscalene block versus mobilization and intraarticular steroid injection in frozen shoulder

Background: Painless and early aggressive mobilization of the shoulder can give good outcomes in a frozen shoulder (FS).Objectives: Our objective is to compare the early and late clinical and functional outcomes of mobilization under continuous interscalene block (CISB) and mobilization and intraarticular steroid injection (IASI) and to determine the effect of the addition of IASI on mobilization and CISB in adults with FS.Methods: We conducted a prospective comparative study. Participants were divided into 3 groups of 20 patients. The allocation was performed by simple randomization. The primary outcomes of pain and patient satisfaction were assessed using VAS scores. Outcome measures such as pain, patient satisfaction, range of motion, and UCLA scores within the groups were assessed.Results: The majority of patients were females. There was a significant improvement in early pain relief and range of motion in patients treated using mobilization under CISB. The late functional outcomes were similar in all groups irrespective of the method of treatment. The IASI had no significant effect on the early or late outcomes of mobilization under CISB.Conclusion: Mobilization under CISB provides early pain relief, improvement in the range of movements, and good long-term functional outcomes in frozen shoulders. IASI does not affect early pain relief or improvement in the range of movements

Idiopathic transient osteoporosis a rare and underdiagnosed entity a case report with a review of the literature

Introduction. Idiopathic transient osteoporosis of the hip is a rare but underdiagnosed condition. It is common in middle-aged men and pregnant women. The exact etiology is unknown. Aim. We present a 52-year-old man presented with progressively increasing pain left hip for two months. Description of the case. The radiograph showed osteoporosis localized to the proximal femur. Magnetic resonance imaging showed bone marrow edema. He was diagnosed as a case of idiopathic transient osteoporosis of the left hip (ITOH) after ruling out other causes. He was treated nonoperatively with analgesics and rest. He was given daily calcium and monthly ibandronate 150mg. His symptoms subsided after 3 months. There was no recurrence of symptoms. Conclusion. We present this case to describe the clinical, radiological features, diagnosis, and treatment of ITOH. Idiopathic transient osteoporosis is a rare condition. It is often not diagnosed because of a lack of awareness and also being a self-limiting condition. The radiogram may be normal. So a high index of suspicion is needed for its diagnosi

Multi Drug Resistant Tuberculosis

Introduction. Tuberculosis is one of the oldest infections known to mankind. Of all infectious diseases, tuberculosis causes the most fatalities of any infection. The incidence of tuberculosis on the rise due to the increased prevalence of HIV infection. The incidence of drug resistance strains of mycobacterium is also on the rise. When the mycobacterium is resistant to both INH and rifampicin it is called multi drug resistant tuberculosis. There is a primary and an acquired type of drug resistance. Multidrug resistant tuberculosis is a not only a problem for the patient but also for society at large. The treatment of multidrug resistant tuberculosis requires an entirely different approach. Aim. In this review, we are going to describe the etiopathogenesis, diagnosis, investigations and treatment of multi drug resistant tuberculosis. Material and methods. Analysis of the current literature. Results. Genetic factors, previous treatment, and other factors predisposes the onset of drug resistance. By early detection and prevention of spread of drug resistant strains we can prevent the spread of resistant strains. Conclusion. Drug resistance in tuberculosis is a very complex and dangerous problem. We have to prevent the development and spread of MDRTB. Good quality drugs should be used and made available to all sections of the population. Enhancing the National tuberculosis programs is the best way to attain an effective way to control this menace

Multi Drug Resistant Tuberculosis

Introduction. Tuberculosis is one of the oldest infections known to mankind. Of all infectious diseases, tuberculosis causes the most fatalities of any infection. The incidence of tuberculosis on the rise due to the increased prevalence of HIV infection. The incidence of drug resistance strains of mycobacterium is also on the rise. When the mycobacterium is resistant to both INH and rifampicin it is called multi drug resistant tuberculosis. There is a primary and an acquired type of drug resistance. Multidrug resistant tuberculosis is a not only a problem for the patient but also for society at large. The treatment of multidrug resistant tuberculosis requires an entirely different approach. Aim. In this review, we are going to describe the etiopathogenesis, diagnosis, investigations and treatment of multi drug resistant tuberculosis. Material and methods. Analysis of the current literature. Results. Genetic factors, previous treatment, and other factors predisposes the onset of drug resistance. By early detection and prevention of spread of drug resistant strains we can prevent the spread of resistant strains. Conclusion. Drug resistance in tuberculosis is a very complex and dangerous problem. We have to prevent the development and spread of MDRTB. Good quality drugs should be used and made available to all sections of the population. Enhancing the National tuberculosis programs is the best way to attain an effective way to control this menace

The Effect of Patellar Denervation by Circumpatellar Electrocautery on Anterior Knee Pain Following Total Knee Replacement – An Experimental Study

ABSTRACT OBJECTIVES Anterior knee pain is a common problem in patients who have undergone TKR which causes dissatisfaction among them. There are Various methods for prevention of anterior knee pain following TKR .The  objective of this study is to determine the  effect of circumpatellar electrocautery on anterior knee pain following TKR and to compare the results with that of those patients who have undergone TKR without circumpatellar denervation. METHODS This is a cohort study conducted in Dept. of Orthopedics, Govt. Medical College, Kozhikode,kerala, 2014. Total sample size was 90.out of which 2 patients died during the study period. We lost follow up of 7 patients.  Among the remaining 81 patients 42 had undergone TKR with circumpatellar denervation using electocautery and 39 without circumpatellar denervation. They were kept under follow up. Patients were followed up postoperatively at 1 month, 3 months, 6 months and at one year. At all postoperative visits, a clinical score was determined using the Knee Society score and the clinical anterior knee pain rating system described by Waters and Bentley RESULTS There is no statistically significant difference in AKP score between both groups.There is a statistically significant difference in the knee society score at 1st month(p value <.001).  But there is no difference on further follow up visits . CONCLUSION There is no statistically significant difference between final outcome of patients who underwent patella denervation using circumpatellar electrocauterisation and those without denervation  with respect to anterior knee pain among patients who have undergone TKR