Background: Hemiarthroplasty is now being considered as a primary treatment for comminuted unstable type of IT fracture in elderly on the grounds that it allows early mobilization and full weight bearing. Recently popular modality is fourth generation of intramedullary nails like the Proximal Femoral Nails. The goal of treatment is restoring mobility safely and efficiently, while minimizing the risk of medical complications and technical failure.Methods: A Forty patients, having Intertrochanteric fractures treated with PFNA or cemented BH at our institution between April 2016 and April 2017. The primary outcomes measures were postoperative complication and hip function. The secondary outcome measures were intraoperative blood loss, transfusion rate, surgical time, postoperative haemoglobin and hospital stay.Results: Seventeen patients in PFNA group and 23 patients in BH group were included for analysis. There were no significant differences between the two group regarding to the Harris Hip Score at 6 months follow up. Significant differences were found between PFNA and BH group in comparison of intraoperative blood loss (p < 0.001), length of stay (p = 0.006), surgical time (p < 0.001), postoperative transfusion (p < 0.001), and decrease of hemoglobin (p=0.001).Conclusions: These findings indicate that PFNA has obvious advantages over the BH in treatment of intertrochanteric fractures in case of surgical trauma and postoperative complication.
Background: Cervical spondylotic myelopathy (CSM) is a clinical disease which characterized by degeneration of the intervertebral discs and nearby spinal structures. The goal of this study is to compare laminoplasty (LP) versus laminectomy and fusion (LF) for multilevel cervical spondylotic myelopathy (CSM) in terms of clinical safety and effectiveness. Methods: This study is a meta-analysis from randomized and non-randomized control study. The database being used were PubMed, Google Scholar, Cochrane Registry, and Embase. The authors extensively searched the relevant papers comparing the clinical efficacy and safety of LF and LP for the therapy of multilayer CSM. The outcome measures recorded were visual analog scale (VAS), cervical curvature index (CCI), The Japanese Orthopaedic Association (JOA) scores, Nurich grade, reoperation rate, complications, and rate of nerve palsies. The analysis were performed by using RevMan 5.3. Results: Our meta-analysis includes a total of 14 papers. The pooled mean difference between LF and LP was insignificant in terms of VAS of neck pain (p=0.54), post-operative CCI (p=0.24), JOA score (p=0.29), Nurich grade (p=0.16) and reoperation rate (p=0.21). The complication and nerve palsies rate was higher in LF group compared to LP group (OR 2.60, 95% CI 1.85, 3.64, I2=26%, P < .00001) and (OR 3.18, 95% CI 1.66, 6.11, I2=47%, P=.0005) respectively. Conclusion: Our meta-analysis demonstrates that the majority of clinical outcomes for surgical treatments of multilevel CSM utilizing LF and LP are comparable. However, it was discovered that LP was superior compared to LF in terms of nerve palsy rate. This needs additional validation and research in more extensive sample-size and randomized studies.
Total knee replacement (TKR) is considered to be among the most successful type of orthopedic surgery, with 15-year-survival-rate of implant exceeding 95%; furthermore, the improvement in quality of life is very significant. This study aims to describe the demographics, length of hospitalization and short-term outcome observed in patients undergoing TKR at Sanglah Hospital in 2018. All patients undergoing TKR at Sanglah Hospital in 2018 have been prospectively entered into our database. A total of 59 patients were recorded on 2018 for this study and 1 revision TKR patient and 2 patients with incomplete data were excluded. At baseline, 78.6% patients were female, 72.3% were Balinese and 84.1% were housewives. The mean age of patients was 63 years old. Authors also record that 44 (78.6%) patients are Overweight patients (BMI 25.00-29.99 kg/m2), 11 (19.6%) patients are at Obese Class I (30.00-34.99 kg/ m2) range, and only 1 (1.8%) patients have normal weight (18.50-24.99 kg/m2). As many as 51.8% patients had right TKR and 49.2% left TKR. The modus of patient’s length of stay is 7 days with 27 (48.2%) patients started to walk on the 4th day. VAS was recorded at level 4/10 on 92.9% patient. Drain was removed after 3 days on 42 (75%) patients. 15 patients (26.8%) had PRC transfusion due to anemia after operation.
Background: Osteonecrosis of the femoral head (ONFH) is a disease in which local death of osteocytes and the component of the bone marrow occurs owing to venous stasis or arterial blood supply damage or interruption in the femoral head. Developmental dysplasia of the hip (DDH) is characterized by an abnormal anatomical relationship between the femoral head and acetabulum, and includes acetabular dysplasia, subluxation and in the most severe cases, development dislocation of the hip joint. Total Hip Arthroplasty (THA) is among the most successful orthopedic procedures worldwide. For acute and chronic hip diseases, THA can relieve joint pain, correct deformities, and restore and improve hip function. This study aims to understand the efficacy of Uncemented Total Hip Arthroplasty as the treatment of choice for osteonecrosis of the femoral head and late diagnosed developmental dysplasia of the hip in young adult patient. Case Report: We present a case of osteonecrosis of the femoral head and late diagnosed developmental dysplasia of the hip in a 32 years old active male. He had a history of falling trauma from a height of about 1.5 meters at the age of 12 years (20 years ago), and at that period the patient was diagnosed with right femoral head fracture and had a special condition, namely developmental dysplasia of the hip, since that incident the patient had not been looking for any treatment and was unable to walk normally and always had a limping gait. Uncemented Total Hip Replacement procedure is chosen and performed successfully with good outcomes within 16 weeks after the procedure. Discussion: Uncemented and cemented replacement had satisfactory long-term survival but they differed in their modes of failure. Patients who undergo total hip arthroplasty for osteonecrosis of the femoral head are younger and more active compared to those with osteoarthritis, showing a high likelihood of future revision procedures. Therefore, cementless applications is more appropriate alternative in young adult patient with osteonecrosis of femoral head. Conclusion: Uncemented Total Hip Arthroplasty in young adult male patients with osteonecrosis of the femoral head and late diagnosis of DDH is a suitable option and has a high level of the functional effectiveness and good material durability.
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