Outcome of pedicle screw fixation with transpedicular bone grafting in fracture of thoracolumbar vertebrae

Background: Posterior short segment instrumentation for thoracolumbar fracture is known for high implant failure rate because of the lack of anterior support. Anterior body augmentation by transpedicular bone grafting has been developed as an alternative to overcome this failure. In this study, we have evaluated the outcome of the cases of the unstable thoracolumbar spine injuries managed surgically with pedicle screws and transpedicular bone grafting.Methods: 20 patients were included in this study and were followed up for up to 6 months postoperatively. We assessed the outcome of each patient with Frankel scale and visual analog score (VAS) post-operatively clinically and radio logically by measuring Cobb’s angle and anterior vertebral body height post-operatively on follow-up at 6 weeks, 12 weeks, and 24 weeks.Results: We found that males had higher incidence with most common mode of injury was fall from height. D12 was single most involved vertebrae. The average Cobb’s angle during preoperative stage was 12 degrees and 22.05 degrees at 6th week and this was maintained till 24th week. The mean difference of anterior vertebral body height between pre-operative and 24th post-operative week was 7.15 mm. The mean VAS pre-operatively was 9.8 which changed to 0.75 at 24 weeks follow up. These were statistically highly significant.Conclusions: Our study established that Pedicle screw fixation with transpedicular bone grafting has a satisfactory result and can restore vertebral height, increase the stability of the injured vertebrae and leads to a significant improvement in the patient’s quality of life

Comparison of functional outcomes between cemented and uncemented bipolar hemiarthroplasty for intracapsular neck femur fractures

Background: The neck of femoral fracture is common and leading fracture in orthopaedic practice. The older age group and female are more to prone to develop this fracture.Methods: A prospective, clinical observational, analytical comparative study was undertaken in the department of Orthopaedics of Geetanjali Medical College and Hospital in Udaipur, Rajasthan from January 2018 to June 2019. 52 adult patients with neck of femur fracture, 26 patients in each group. Results: In our study, the mean age was 77.72 years. Female preponderance was seen in our study. In our study mean duration of surgery in uncemented group was 65.78 minutes and mean duration of surgery in cemented group was 79.89 minutes. The mean total HHS in our patient was 86.63 with standard deviation of 6.18. Mean HHS for cemented group was 86 and for uncemented group was 87.23. We found 20 excellent result and 27 good results (35.71% and 51.92% respectively). We also found 5 fair result (12.37%). There were 2 complications, both in cemented group, one had post-operative dislocation and other had a cement reaction.Conclusions: Both cemented and uncemented hemiarthroplasty are equally good options in the treatment of femoral neck fractures in the elderly. However, it is to be noted that the duration of surgery & complications, were both less in the uncemented group as compared to cemented hemiarthroplasty group in our study.

A comparative study of functional outcome between platelet rich plasma injection versus steroid infiltration in plantar fasciitis

Background: Plantar fasciitis (PF) is considered as degenerative tendinopathies. Repeated micro trauma is the major etiology of these diseases. Autologous platelet rich plasma (PRP) injections are becoming more popular in the treatment of enthesopathies like PF. The growth factors in PRP cause tissue healing. We compared the result of injecting intra-lesional autologous PRP injections versus steroid infiltration in chronic PF.Methods: A prospective, interventional and analytic comparative study was done and 81 patients (120 heels) were included in this study and were followed up for 6 months. We assessed the outcome of each patient using visual analog score (VAS) and foot and ankle disability index (FADI) on follow-up at 1, 3, and 6 months. Results: In our study, female preponderance was seen. Left side was more common as compared to right side. Unilateral PF is more common than bilateral. The difference with in the individual group at baseline and at 1,3 and 6 months was statistically highly significant in terms of VAS and FADI (p=0.0001) But the difference in the between the two groups was insignificant for VAS and FADI at 1, 3 and 6 months.Conclusions: In our study, as there is no significant difference in VAS and FADI score between corticosteroid injection group and PRP injection group at 1, 3 and 6 months follow up. So, it’s reasonable to conclude that both are equally effective in PF. But as PRP injection comes out to be more time consuming and more costly, corticosteroid seems to be more efficient, cost and time wise. Hence, the latter should be a better choice.