Background: Intertrochanteric fracture is a common condition seen in elderly population which is managed with operative procedure in the department of orthopedics. The proximal femoral nail antirotation (PFNA) system was developed by the AO/ASIF in 2004 for this fracture that provides optimal anchoring and stability when the implant is inserted into the osteoporotic bone. The main characteristic of the implant is the use of a single blade with a large surface area and insertion of the blade compacts the cancellous bone. Aims and Objectives: The aim of the study was to study the functional outcome of intertrochanteric fracture managed with PFNA2. Materials and Methods: The prospective and observational study was conducted in patients diagnosed with intertrochanteric fracture admitted in orthopedic ward, Western Regional Hospital, Pokhara. Pre- and post-operative fracture alignment, Harris hip score (HHS), post-operative complications were taken into account. Results: Out of 55 cases taken into study, 36 (65.45%) were male and 19 (34.55%) were female. Maximum number of patients allocated in our study falls in 71–80 years group (29%) with least number in age group of 90 years or more (1.9%). Right-sided intertrochanteric fracture were 27 (49%) and left side involved were 28 (51%). Twenty-eight (51%) falls in Type II and 27 (49%) falls in Type III Boyd and Griffin intertrochanteric fractures. There was a marked improvement in fracture alignment after the operation with various parameters taken into consideration. Pre-operative HHS was 5.52±5.38 (Poor) and immediately after the procedure, it was 30.41±3.04 (Poor), 89.86±3.59 (Good) at 6 months, and 95.56±1.257 (Excellent) at 12 months. One case had blade cut out at immediate post-operative period, eight cases had surgical site infection, and five cases had GT fracture. Conclusion: This study showed that PFNA2 is an effective operative procedure in management of intertrochanteric fractures by achieving better fixation through bone impaction especially in osteoporotic bone.
Background: Melasma is a common acquired pigmentary disorder that is aesthetically displeasing. Kligman’s and Modified Kligman’s formula using topical steroids, hydroquinone and retinoids, and various other depigmenting agents is being widely used all over for melasma with varying results. Chemical peeling is newly added to the therapeutic armamentarium and is showing encouraging results worldwide in patients with melasma. However, comparative studies are lacking in abundance in our part of the world. Aims and Objectives: To determine if serial trichloroacetic acid peels provide additional benefits when combined with time-tested topical therapy with hydroquinone 4% in patients with melasma. Materials and Methods: Fifty melasma patients were divided into two groups of 25 each. One group received serial trichloroacetic acid peel combined with topical hydroquinone 4%. The other group only received topical hydroquinone 4% cream. The results were evaluated by a clinical investigator both subjectively and with photographs taken at baseline, 12 weeks, and 21 weeks. For clinical evaluation, the melasma area and severity index (MASI) was used. Results: A significant decrease in MASI score from baseline to 21 weeks was observed in both groups (P<0.001). The group receiving the trichloroacetic acid peel 20% showed a trend toward more rapid and greater improvement, with statistically significant results (P<0.001). Only a few side effects were observed in the peel group. Conclusion: This study demonstrates that serial trichloroacetic acid peels provide an additional effect to a topical regimen of 4% hydroquinone cream for treating melasma in Fitzpatrick skin types III and above if used judiciously and under supervision. It demonstrates that superficial chemical peels can be used as an adjunct with better efficacy to treat patients with melasma.
Background: The neck of femur fracture is a major public health problem due to ever increasing aging population. Its incidence has drastically increased forthe past few decades. Total hip replacement (THR) is the most common treatment option for displaced fracture neck of femur in high demanding patients who is cognitively intact, independently mobile, and active. Drains have been used with varying success in orthopedic surgery for many years. There are several studies done regarding the utility of drain with conflicting results. Aims and Objectives: To observe the pattern of fall in hemoglobin (Hb) in post-operative patients of fractured neck of the femur with and without drain undergoing THR. Materials and Methods: Observational study was conducted in admitted patients with Fracture Neck of Femur who will be undergoing THR with (cases) and without drain(controls). Pre-operative Hb, Post-operative Hb from day 1 to 5, Length of Hospital Stay, mobilization were taken into consideration for both arms. Results: Among 35 cases studied in each arm,45 were male and 25 were female with male: female ratio of 1.8:1.Maximum number of patients allocated in our study falls in the 60–65 years group (68.58%) followed by the age group of 66–70 years(11.42%) with least number in the age group of 80 years or more (2.84%).Average pre-operative Hb of patients with drain group was 10.6 gm% and non-drain group was 10.2 gm %.Post-operative Hb fall was observed up to first three POD.Mean hospital stay of patients in CSD was 10.9 days as compared to no CSD which was 8.4 days P=0.000*. Mean day of mobilization of patients in CSD was 1.9 days s compared to no CSD which was 1.8 days P=0.291. Conclusion: This study showed keeping drain has more blood less as compared to non drained group.Similarly, CSD had more hospital stay as compared to no CSD but there was no any association with day of mobilization in both arms.
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