The free hand technique remains the most popular method for distal locking; however, radiation exposure is a major concern. In an endeavour to overcome this concern, distal locking with the nail over nail technique is evaluated. Seventy patients with femoral diaphyseal fractures treated by intramedullary nailing were divided in two groups for distal locking: either using the free hand technique (group I) or with the nail over nail technique (group II). The average number of images taken to achieve nail insertion without locking, for distal locking, and for the complete procedure in group I was 25.8, 24.2, and 50.08, respectively, compared with 24.8, 4.1, and 28.9, respectively, in group II (statistically extremely significant decrease in radiation). The nail over nail technique appears to be a reliable solution for decreasing radiation exposure during closed femoral intramedullary nailing. However, over-reaming of 1.5 mm is the key to the success of the technique.
Reconstruction of the anterior cruciate ligament using autografts is a common procedure performed in the modern era. The peroneus longus tendon is an upcoming graft with several advantages over traditional autografts. It has minimal donor site morbidity in relation to biomechanical properties of the ankle. Common peroneal nerve injury during harvest is a theoretical concern while harvesting the peroneus longus tendon. The following case highlights the importance of careful surgical technique and timely intervention while dealing with such complications. A 25-year-old male suffered an anterior cruciate ligament rupture while wrestling. He had an unstable knee and difficulty performing daily activities. He underwent an arthroscopic anterior cruciate ligament reconstruction using peroneus longus tendon autograft. Following surgery, the patient reported a foot drop and decreased sensations over the dorsum of the foot. The patient was advised of a foot drop splint and neuroprotective medications. Neurophysiological studies were not performed since they cannot differentiate between partial and complete nerve injury in the first week after injury. A surgical exploration of the nerve was done. An intraneural hematoma was found with contusions over the peroneus longus tendon. Neurolysis was performed to decompress the nerve. The functioning of the anterior cruciate ligament was satisfactory during follow-up. An advancing Tinel's sign was noted on followup. The patient finally recovered after a 3-month follow-up.
Introduction- Aside from other multisystemic symptoms, musculoskeletal symptoms are quite common in patients with COVID-19. Post covid there has been a rapid rise in diffuse complaints of myalgia and joint pain. This study was designed to calculate the prevalence of musculoskeletal symptoms in post-COVID 19 cases.
Material & Methods- This was a cross-sectional single-centre study carried out at Pt. B. D. Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana. Patients aged more than 18 years who were diagnosed with COVID 19 without any previous history of musculoskeletal manifestations and a minimum of 21 days of negative RT-PCR report were included in the study.
Results- 249 patients with a history of Covid 19 participated in the study and presented with musculoskeletal manifestations. Lower back pain (37.3%) was the most common symptom in patients with post-covid musculoskeletal symptoms, followed by, shortness of breath (34.1%), arthralgia (33.7%), myalgia (31.4%), upper back pain (26.5%) and only a few patients with post-covid reactive arthritis (1.2%). Fatigue was reported by almost all the study subjects.
Conclusion- Generalised fatigue, diffuse muscle and joint pain are quite frequently seen in post COVID patients which amounts to a huge patient load presenting to Orthopaedic clinics.
Keywords- Covid19, Myalgia, Musculoskeletal, Arthralgia
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