Background:Bone loss following open fracture or infected gap nonunion is a difficult situation to manage. There are many modes of treatment such as bone grafting, vascularized bone grafting and bone transport by illizarov and monolateral fixator. We evaluated the outcome of rail fixator treatment in reconstructing bone and limb function. We felt that due to problems such as heavy apparatus, persistent pain, deformity of joints and discomfort caused by an Ilizarov ring fixator, rail fixator is a good alternative to treat bone gaps.Materials and Methods:20 patients (17 males and 3 females with mean age 30.5 years) who suffered bone loss due to open fracture and chronic osteomyelitis leading to infected gap nonunion. Ten patients suffered an open fracture (Gustilo type II and type III) and 10 patients suffered bone gap following excision of necrotic bone after infected nonunion. There were 19 cases of tibia and one case of humerus. All patients were treated with debridement and stabilization of fracture with a rail fixator. Further treatment involved reconstructing bone defect by corticotomy at an appropriate level and distraction by rail fixator.Result:We achieved union in all cases. The average bone gap reconstructed was 7.72 cm (range 3.5-15.5 cm) in 9 months (range 6-14 months). Normal range of motion in nearby joint was achieved in 80% cases. We had excellent to good limb function in 85% of cases as per the association for the study and application of the method of ilizarov scoring system[ASAMI] score.Conclusion:All patients well tolerated rail fixator with good functional results and gap reconstruction. Easy application of rail fixator and comfortable distraction procedure suggest rail fixator a good alternative for gap reconstruction of limbs.
INTRODUCTIONPeripheral nerve block has taken patient care in anaesthesia to a whole new level. Because of the advent of nerve stimulator and peripheral nerve block techniques, even patients in ASA grade 3 and 4 can be taken up for surgery safely. Moreover, with the use of adjuvants in brachial plexus block (BPB), one can extend patient care in the form of extended postoperative analgesia, ensure compliance of patient with physiotherapy and early mobilization of patient with stable haemodynamic variables. Dexmedetomidine is a highly selective α-2 adrenergic agonist with an affinity of 8 times greater than clonidine. 1Various studies have shown that dexmedetomidine prolongs the duration of sensory and motor block and provide a very good analgesia when used as an adjuvant to local anaesthetics for nerve blocks.2-5 The anaesthetic and the analgesic requirement are reduced substantially because of its analgesics properties and augmentation of local anaesthetics (LA) effects as they cause hyperpolarization of nerve tissues by altering transmembrane potential and ion conductance at locus ceruleus in brain stem. Dexmedetomidine provides stable ABSTRACT Background: With the addition of adjuvants to local anaesthetics the onset, duration and quality of brachial plexus block improves to a marked extent. The intent of this study was to compare onset, duration of sensory and motor block along with duration of analgesia when an α-2 agonist dexmedetomidine or a steroid dexamethasone was added to a mixture of 2% lignocaine with adrenaline and 0.5% bupivacaine. Methods: 100 patients belonging to ASAI and ASAII were included in the study scheduled for upper limb surgeries after taking informed consent. These patients were divided in to two groups having 50 patients in each group. Group D received 20ml of 2% lignocaine with adrenaline plus 18ml of 0.5% bupivacaine plus 50μg of dexmedetomidine and group X received 20ml of 2% lignocaine with adrenaline plus 18ml of 0.5% bupivacaine plus 8mg of dexamethasone. Onset of sensory and motor block, duration of block, quality of intraoperative analgesia and duration of analgesia were recorded. Results: Our study revealed similar onset of sensory block in group D and X. Group D showed early onset and longer duration of motor block compared to group X. Intraoperative haemodynamics were similar in both groups. Conclusions: Our study concludes that using dexmedetomidine as adjuvant prolongs the duration of block and postoperative analgesia compared to dexamethasone with minimal or negligible adverse events.
IntroductionPostoperative infection is an uncommon complication with grave consequences following anterior cruciate ligament reconstruction (ACLR). Presoaking of the hamstring graft with antibiotics results in a lower rate of infection. The purpose of the current study was to compare the efficacy of two commonly used antibiotics, vancomycin and gentamicin, in reducing infection rates following anterior cruciate ligament reconstruction. MethodsThe retrospective study included a total of 578 patients who underwent arthroscopic anterior cruciate ligament reconstruction between June 2015 and October 2021. The timeline was categorized as the period between June 2015 to October 2018 (Vancomycin presoaking of hamstring graft) and November 2018 to October 2021 (Gentamicin presoaking of hamstring graft). All patients were examined for the development of infection, causative organism, and treatment received. Patients with intravenous drug abuse, alcoholism, steroid use, revision cases, and a prior history of infection in the knee were excluded from the study. Fisher's exact test was used for comparison of categorical data, and Poisson regression analysis was carried out to calculate incidence rate ratios after adjusting for confounding variables. ResultsPresoaking of hamstring grafts with vancomycin was carried out in 224 patients, and gentamicin was used in 354 patients. In total, three patients in the vancomycin and four patients in the gentamicin groups developed an intraarticular infection, and the difference in infection rate between the two groups was not statistically significant (p=0.919). Coagulase-negative Staphylococcus aureus was isolated in four cases, Enterobacter cloacae in one, and no organism was seen in two cases. The groups were comparable in terms of age (p=0.563), smoking (p=0.84), sex (p=0.359), and operative time (p=0.09). ConclusionPresoaking of hamstring autografts with gentamicin intraoperatively is a good alternative to vancomycin in the prevention of infection following arthroscopic anterior cruciate ligament reconstruction.
Tendons and ligaments are important structures in the musculoskeletal system. Ligaments connect various bones and provide stability in complex movements of joints in the knee. Tendon is made of dense connective tissue and transmits the force of contraction from muscle to bone. They are injured due to direct trauma in sports or roadside accidents. Tendon healing after repair is often poor due to the formation of fibro vascular scar tissues with low mechanical property. Regenerative techniques such as PRP (platelet-rich plasma), stem cells, scaffolds, gene therapy, cell sheets, and scaffolds help augment repair and regenerate tissue in this context. Therefore, it is of interest to document known data (repair process, tissue regeneration, mechanical strength, and clinical outcome) on applied regenerative medicine in tendon healing.
Musculoskeletal diseases affect millions of people worldwide and are one of the leading causes of long-term pain and physical disability. Traditional treatment methods for promoting healing and repair has always been consider gold standard, But the emergence of new therapeutic approaches aims to regenerate or repair musculoskeletal tissue. The recognition of a regenerative therapy in orthopaedics requires the demonstration of new Bone, Cartilage, ligament, tendons, healing of soft tissues injuries and Overuse conditions like plantar fasciitis or tennis elbow . Regenerative therapy boosts the body’s ability to use its repair systems to heal diseased or damaged cells after a severe injury, or other degenerative condition. A diversity of regenerative strategies have been evaluated, including distraction osteogenesis, bone grafts and bone substitute materials, bone matrix proteins, growth/differentiation factors, combined therapies and, more recently, tissue‐engineering approaches. This review aims to evaluate the current status of the therapies available and to discuss the challenges that must be faced in order to achieve predictable orthopaedic regeneration in clinical practice.
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