Post-operative pain management in Total Knee Arthroplasty (TKA) remains a challenging issue even though it is a commonly performed procedure today. Majority of the patients report severe pain following surgery due to which mobilization and early rehabilitation is hampered. Therefore, appropriate pain management is the need of the hour and Local Infiltration Analgesia (LIA) using periarticular cocktail injection is one of the preferred techniques. The objective of this study was to assess the functional outcome and patient satisfaction after using LIA in the form of periarticular Ranawat-cocktail among post-TKA patients. Materials and Methods: This study was conducted at SGITO, Bangalore during the period between August 2017 to April 2018. In this study, we used LIA consisting of the Ranawat Regimen for TKA patients which contains (bupivacaine with adrenaline, morphine, methylprednisolone, cefazoline and normal saline) to manage postoperative pain in all 53 patients presenting to our institute for primary TKA. Functional outcome was assessed in terms of post-op VAS score, ROM, and SLRT at 12hrs, 24hrs, and 48hrs post-op. Opioid consumption, and patient satisfaction was recorded and statistical analysis was done. Results: The mean age of patients in the study was 60.83. Mean VAS pain score at 12hrs, 24hrs, and 48hrs post-op were found to be 5, 3.5 and 2.79 respectively which indicated a highly significant (p<0.001) reduction in pain following TKA. Majority of the patients (71.7%) did not require any opioid rescue analgesia. Post-op ROM was satisfactory and all patients were able to do SLRT by day 1 and there was excellent patient satisfaction at time of discharge. Conclusion: Local Infiltration Analgesia is a safe, simple and efficient method of reducing postoperative pain after total knee arthroplasty (TKA) which facilitates early rehabilitation among the patients and has an overall improvement in patient satisfaction with the procedure.
Femoral neck fractures and pertrochanteric fractures are of approximately equal incidence and together make up over 90% of the proximal femur fractures and the remaining 5-10% is subtrochanteric. The femoral neck fractures are only 2% in patients with age under 50 years. After 50 years, the incidence is doubled for each subsequent decade and it is 2 to 3 times higher in women than in men. The overall annual age-standardized rates of femoral neck fractures are higher among white women than among black women. A prospective study was conducted on patients with acute fracture neck of femur aged above 60 years treated with THA in the Department of Orthopedics. Clearance from the institutional ethics committee was obtained before the study was started. An informed, written and bilingual consent was obtained before the study was started. About 40% of study subjects presented to the hospital at 2 -5 days, 35% presented on 1 st day, 17.5% presented on 6 -10 days and 7.5% presented after 10 days of fracture.
A basic understanding of the mechanism of fracture production has always aided in the treatment of specific fractures. Tibial plateau fractures are usually caused by high velocity trauma causing valgus or rarely varus force with or without axial loading as in road traffic accidents (Bumper fracture) or fall from a height. Valgus loading in the range of 2250 to 3750-inch pounds produce "mixed" fracture with large variation in the amount and the degree of joint and condylar disruption. This study of surgical management of proximal tibial fractures was conducted in the Department of orthopaedics and during study period, 30 patients were treated for proximal tibial fractures were treated by open reduction and internal fixation with buttress plate and LCP. Out of which 4 cases lost for follow up. All the required data was collected from the patients during their stay in the hospital, during follow up at regular intervals and from the medical records. 30 cases of fractures of the proximal tibia were treated with plate osteosynthesis. The follow up ranged from 6-24 months. Males were predominant. Majority of fractures were due to Road Traffic Accidents. The average age of the affected patients was 40 years. Most of the fractures were closed.
Standard open reduction and internal fixation techniques have been successful in restoring osseous alignment for proximal tibial fractures; however, surgical morbidity, especially soft tissue infection and wound necrosis, has been reported frequently. For this reason, several investigators have proposed minimally invasive methods of fracture reduction. To our knowledge, there have been no studies to assess the functional outcome of these fractures. During study period 30 patients were treated for proximal tibial fractures treated by open reduction and internal fixation with buttress plate and LCP. Out of which 8cases lost for follow up. In the present study there were 26 proximal metaphyseal fractures managed plate osteosynthesis. All the fractures united at an average of 13 weeks. There were 4 excellent, 16 good and 2 fair, 1 poor results. There were 1 patients with superficial infections which healed with regular dressings, no patients (5%) with knee stiffness, 2 patients with knee pain, no patients with delayed union, 1 patient with non union. Plating offers a good treatment option for difficult proximal tibial fractures, because plateosteosynthesis provide improved healing rates, restoration of the articular surface, and decreased complications.
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