INTRODUCTIONThe plantar fascia is a common condition in which a fibrous aponeurosis begins at the plantar medial calcaneal body, spreads over the plantar midfoot, and then divides distally to attach at the plantar aspect of all five proximal phalanges. 1 It is frequently seen among sportspersons, accounting for more than 25% of disorders of the foot in athletes. 2 In general population, plantar fasciitis is responsible for 7% of cases of foot pain in the population over 65 years of age. 3 The first line of management is conservative, which includes nonsteroidal antiinflammatory drugs, corticosteroid injections, cast or controlled ankle motion boot immobilization, night splinting and therapeutic exercise. Less common nonoperative methods have been attempted in past with some success like extracorporeal shock wave therapy and platelet-rich plasma injections. 4,5 But the evidence is insufficient to support its widespread use among the patients. Operative management procedures like plantar ABSTRACT Background: The plantar fascia is a common condition, for which there is no consensus on the best treatment option. The aim of this study is to compare the pain and fascia thickness outcomes of patients treated with botulinum toxin A injection versus corticosteroids injection. Methods: 50 patients of plantar fasciitis randomly received injections of either botulinum toxin A (100 units in 2.5 ml normal saline) or methylprednisolone (2 ml of 40 mg/ml) under ultrasonographic guidance. Patients were assessed for pain using the visual analogue scale (VAS) and fascia thickness at baseline, 1 and 3 week, 3, 6 and 12 months post injection. Patients in the two treatment groups were compared for pain scores and thickness at each follow up. Results: There were no significant differences in the patients in both the groups at baseline. Patients in both the groups had significant improvement in VAS pain scores over a 12 months follow-up. At the end of the study (12 month follow up), the VAS pain score was significantly lower in the group of patients who received botulinum toxin A (1.68±0.62 vs. 4.72±1.02, p value=0.001). There was a significantly less plantar fascia thickness in the group of patients who received botulinum toxin as compared to those who received corticosteroids at the 3 week, 3 month, 6 month and 1 year follow up. Conclusions: Better clinical outcomes were observed with botulinum toxin type A as compared to corticosteroids. Similar studies need to be replicated with larger sample sizes before this can be offered as a standard treatment for plantar fasciitis patients.Cite this article as: Samant PD, Kale SY, Ahmed S, Asif A, Fefar M, Singh SD. Randomized controlled study comparing clinical outcomes after injection botulinum toxin type A versus corticosteroids in chronic plantar fasciitis. Int J Res Orthop 2018;4:672-5.
Background and Objectives: Technological advancements in the field of knee arthroplasty is leading to an increased number of surgeries being performed every year. This upward trend is due to the aim of the operating orthopaedicians to achieve the most accurate limb alignment to thereby deliver improved functional outcome. Pre-operative assessment of limb alignment is done by two modalities commonly, scanograms and conventional radiographs. The current study was hence designed to evaluate, validate and compare these pre-operative assessment techniques in terms of their post-operative outcomes. Postoperative outcomes were assessed in different dimensions, namely post-operatively achieved limb alignment was analyzed using scanograms and the functional outcomes using specific outcome tools -WOMAC score and Oxford Knee score. Methods: A total of 24 subjects (47 knees) were enrolled in the study as per the inclusion and exclusion criteria. Results:The results obtained from our study indicate that despite better neutral alignment was achieved by the use scanograms, it did not provide any significant improvement in the functional outcome of our subjects. Interpretation and Conclusion:The use of scanograms pre-operatively has little practical value and is an additional cost borne by the patient. More large scale, organized and sophisticated research needs to be done on the same, to enable its application in orthopedic surgery.
<p><strong>Background: </strong>Proximal humerus fractures constitute 5% of all appendicular skeletal injuries and are mainly a menace of the elderly, after hip fractures and distal radial fractures. According to the NEER’S classification, the decision regarding the treatment of such fractures is dependent on whether the four anatomical segments of the proximal humerus are fractured or displaced.</p><p><strong>Methods: </strong>A total of 50 patients admitted in orthopaedics ward satisfying the inclusion criteria were randomly divided in 2 groups with 25 patients in each group for PHILOS plating and Kirschner wiring management. Groups were compared with respect to their improvement in physical function, pain, quality of life, complications and re-operation rates.</p><p><strong>Results: </strong>Out of the total 50 cases, 20% were type I, 22% type II, 36% were type III fractures while 22% were type IV fractures. Mean DASH questionnaire was comparable between two groups at 1 month after surgery (p=0.56). During immediate post-op period and at subsequent follow ups, DASH questionnaire was better in plating group as compared to K-wiring. At 3 months and 6 months follow up, functional outcome as calculated by DASH questionnaire was comparable between two groups (p=0.17 and 0.45). Excellent to good outcome was seen in all cases of either group. No difference was observed between study groups with respect to associated complications. K-wire loosening was observed in 2 cases (8%). Plating was associated with infections (8%) and screw break out (4%).</p><p><strong>Conclusions:</strong> After comparing both the techniques, we recommend PHILOS plating for young adults and percutaneous K wire fixation for the elderly age group.</p>
Background: Adenocarcinoma prostate is one of the significant causes of death in men. The Gleason Grading System is the most commonly used mortality to assess the degree, yet, identical results among blinded pathologists are challenging to obtain and hence come down to an unobjectionable result. Aim and Objectives: To evaluate the relationship between histopathologically obtained Gleason’s Grading Score and various nuclear morphometric parameters using a computer-aided system in Prostatic Adenocarcinomas. Methods: A series of 31 new and histopathologically diagnosed cases of adenocarcinoma prostate will be taken over one year, and the following nuclear morphometric parameters will be studied: mean nuclear area, mean nuclear length, mean nuclear perimeter, mean nuclear roundness factor, mean nuclear area factor and mean nuclear form ellipse. These individual parameters will be correlated with the Gleason Score of the individual cases. Expected Outcome: The present study expects the nuclear atypia to be more in cases with a higher Gleason Score and avoid the inter-observer contradictions in diagnosis. It can be used as a tool to quantify the aggression of the malignancy and, thus, assess disease progression and prescribe a justifiable management protocol. Nuclear morphometrical analysis can be a more accurate, objective, and effective method in the diagnostic and prognostic significance of prostate adenocarcinoma.
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