Context:Osteoarthritis (OA) is a degenerative disorder characterized by pain, stiffness, and loss of mobility of the joint. As the most prevalent form of arthritis and a leading cause of impairment, it is imperative to understand the treating doctor's perception of pain relief among these patients.Objectives:To assess orthopedists’ perspectives on pain management in OA.Materials and Methods:In this qualitative study, a guide-based interview was conducted on 15 orthopedists of a tertiary care hospital and audio-recorded simultaneously. A grounded theory approach was adopted for data transcription with an inductive approach for thematic manual analysis.Results:Five themes emerged - (1) quality of life: OA produces significant disease burden causing severe impairment; (2) pain management: although patients usually demand immediate pain relief, a multipronged approach to treatment emphasizing on physiotherapy and surgery rather than analgesics is needed. Most participants preferred individual discretion while others felt the need for systematizing pain management; (3) precautions/side effects of treatment: paracetamol is often prescribed due to its better benefit − adversity profile as compared to nonsteroidal anti-inflammatory drugs and weak opioids; (4) barriers: participants expressed several barriers to optimal pain management; (5) counseling: Participants concurred that counseling would improve patients’ quality of life.Conclusions:Participants agreed that OA being associated with debilitating pain and impairment requires optimal pain management for improving patients’ quality of life. As crucial as counseling is, it is often compromised due to the large outpatient load. The doctors concurred that a multi-disciplinary team approach is needed to integrate and optimize pain management in OA.
Fat embolism syndrome (FES) is a serious life-threatening manifestation of the fat embolism phenomenon characterized by Bergman’s triad of dyspnea, petechiae and mental confusion. While fat embolization into systemic circulation is common, FES occurs in a meagre 0.05%–3% of patients having isolated long bone fractures. Though visual symptoms are commonly attributed to fat embolism retinopathy and is a later occurrence, it may not always be the case. Cortical blindness has been seldom reported in association with FES, and less so as a presenting complaint. Furthermore, no previous literature has described the same in context of an isolated tibia fracture. We report a 20-year-old gentleman with an isolated right tibia shaft fracture who developed sudden onset diminution of vision in both eyes less than 24 h following trauma with no other complaints. Lack of any remarkable ophthalmoscopic findings or other symptoms left us with a diagnostic conundrum. He later went on to develop altered mentation, hypoxia and generalized tonic-clonic seizures with subsequent MRI revealing multiple cerebral fat emboli also involving both occipital lobes. Supportive measures were instituted and his general condition as well as vision gradually improved following which he underwent plate fixation of the fracture under spinal anaesthesia. The perioperative period was uneventful and he was discharged following staple removal. At one month of follow-up, the patient had no residual visual field defects or neurological deficits. Though FES is rare among isolated tibia fractures, this clinical catastrophe may strike in any unsuspected setting thereby warranting a high index of suspicion to ensure early diagnosis and improved patient outcomes.
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