BACKGROUNDThe epidural technique became popular as it has some specific advantages over spinal anaesthesia. The feasibility of extended duration and differential blockade extended its application into other fields like post-operative analgesia, chronic pain relief and obstetric pain relief. But some inherent negative points of epidural technique like delayed onset and patchy analgesia persist. Various attempts have been made to rectify these negative points. Analgesic effects of magnesium sulphate on peripheral nerves may be due to the antagonism of NMDA receptors, thus preventing central sensitisation from peripheral nociceptive stimulation. Also, magnesium competitively blocks calcium influx into presynaptic endings leading to reduced acetylcholine release. The aim of the study is to add magnesium sulphate as an adjunct to epidural Bupivacaine and evaluate the impact of magnesium sulphate on the quality of the block using the following parameters; Onset of sensory blockade, Motor blockade quality, two segment regression time, Post-operative analgesia and Impact of magnesium sulphate on haemodynamic changes.
MATERIALS AND METHODSThe common age group affected was 21-30 years with mean age being 35.5 years (13-60 years). Most of the injuries were caused by industrial accidents (57.6%). In 34.6% of cases, the dominant hand was involved. All patients were treated with wound debridement, external fixation and early mobilisation of the fingers. The follow-up period ranged between 2.3 -8.2 years (mean 4.4 years). Complications occurred in ten fractures. Loosening of the pin (6) was the most common complication. Except two, all the fractures healed. RESULTSThe functional recovery was analysed using the American Society for Surgery of the Hand (ASSH) criteria of TAM. Results were good or excellent in 86.7% of metacarpal fractures and in 85.7% of Phalangeal fractures with overall result of about 85.9%. Poor results occurred in about 14.1% fractures. Majority of these cases had multiple fractures or accompanied with severe soft tissue injuries. CONCLUSIONTo conclude external fixation is an adequate alternative treatment for unstable open Phalangeal and metacarpal fractures, which are accompanied by severe soft tissue injuries.
BACKGROUND AND OBJECTIVEManagement of femoral and Tibial diaphyseal fractures in the age group of 5-15 years is still controversial between conservative and surgical methods. Compared with young children, this group of children have high risk of malunion and shortening when managed conservatively. Surgical methods are widely used in this age group of children with intramedullary fixation being increasingly preferred. Aim of this prospective study was designed to examine the outcome and complications of Elastic Stable Intramedullary Nailing (ESIN) in the treatment of paediatric fractures of shaft of femur and tibia between 5 to 15 years of age group.
BACKGROUNDFemoral neck fractures are usually observed in the elderly population after a simple fall or minor trauma. In contrast, in young adults, femoral neck fractures are uncommon and are often due to high energy trauma caused by road traffic injuries, work injuries, or fall from a height. The surgical management of femoral neck fractures comprises various options: a) Closed or open reduction with internal fixation of the fracture with screw fixation, b) hemiarthroplasty and c) total hip arthroplasty. Selection of the mode of treatment depends on the patient's age, level of activity, medical comorbidities, degree of bone density, and degree of displacement of the femoral head. We hereby present results of a modified screw fixation technique (Four Quadrant Parallel Peripheral Screw Fixation) in femoral neck fractures of both young and old patients.
BACKGROUND Giant cell tumour is a primary bone tumour. It is benign but locally aggressive neoplasm with a tendency for local recurrence. The aim of treatment is to remove the tumour completely and to preserve the joint. Local recurrence is a well-documented problem. Treatment of recurrent lesions is the same as for primary lesions. This study is aimed at analysing the treatment of the recurrent GCT and aggressive GCT with pathological fracture by adequate curettage using adjuvant like H2O2, liquid nitrogen followed by filling the curetted cavity with bone grafts, bone substitutes and bone cement, thereby preventing the recurrence and to provide structural stability in aggressive GCT with pathological fracture. MATERIALS AND METHODS This is a prospective study of management of 32 cases of Giant Cell Tumour during 2003 to 2007 in Government Kilpauk Medical College, Chennai. Out of the 32 cases, 17 cases were Aggressive GCT with pathological fracture and 15 cases were Recurrent GCT. RESULTS For recurrent GCT, removal of previously applied bone cement, extended curettage with adjuvant Hydrogen Peroxide and reconstruction with bone cement/bone graft/amputation were the treatment methods employed. For Aggressive GCT with pathological fracture, extended curettage with adjuvant H2O2/liquid nitrogen and reconstruction with fibular strut graft/cancellous bone graft, bone substitute and bone cement were the treatment methods employed. CONCLUSION GCT is a locally aggressive benign tumour occurring in young individuals with a normal life expectancy. If inadequately or inappropriately treated, it results in considerable morbidity and recurrence. Careful attention to soft tissue protection while using cryosurgery significantly decreased the previously published reports of high rates of infection and wound healing problem. Hydrogen peroxide is an ideal adjuvant, which gives a comparable rate of recurrence and least local or systemic complications. Free fibular strut graft along with PMMA incorporates in the bone early and the joints can be salvaged with useful function. En bloc resection must also be followed by adjuvant to prevent recurrence due to local tissue contamination.
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