The incidence of hemorrhagic CVA (ICH and SAH combined) was slightly higher than ischemic CVA in this study. Lacunar infarcts in the basal ganglia and also ICH in the basal ganglia were the most common patterns, both are strongly linked to hypertension. A diagnostic protocol of stroke in young adults, to include neuroimaging and other ancillary investigations is advocated for stroke in young adults as some of the etiologies are treatable.
Study DesignNon-concurrent prospective study.PurposeTo determine the functional outcome after open 'fragment' discectomy for recurrent lumbar disc herniation, and to analyze the factors that may affect the outcome.Overview of LiteratureLiterature search revealed only four studies where the factors affecting the outcome of a revision surgery for recurrent disc herniation have been evaluated. None of these studies analyzed for diabetes, disc degeneration and facet arthropathy. We have analyzed these features, in addition to the demographic and clinical factors.MethodsThirty-four patients who underwent the procedure were followed up for an average period of 27.1 months. The Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) were used to assess the functional outcome. Age, gender, smoking, diabetic status, duration of recurrent symptoms, the side of leg pain, level and type of disc herniation, degree of disc degeneration on magnetic resonance imaging, and facet joint arthritis before first and second surgeries, were analyzed as factors affecting the outcome.ResultsThe average Hirabayashi improvement in JOA was 56.4%. The mean preoperative ODI was 74.5% and the mean ODI at final follow-up was 32.2%, the difference being statistically significant (p<0.01). Patients with diabetes, all of whom had poor long term glycemic control, were found to have a poor outcome in terms of ODI improvement (p=0.03).ConclusionsOpen fragment discectomy is a safe and effective surgical technique for the treatment of recurrent disc herniation. However, patients with uncontrolled diabetes may have a less favorable outcome.
Introduction: In humeral shaft fractures management anterior bridge plating is reported as an acceptable less traumatic and reproducible procedure by several authors. Our study done to evaluated the clinical, radiological, and functional outcome of such fractures in 10 patients, all of which were managed with dynamic compression plate over an average follow up period of 16 months. Though open reduction and plating technique of humerus shaft fracture is gold standard, this technique also gives good outcome. Materials and Methods: Ten patients with humerus shaft fractures were managed by anterior bridge plating using Minimum invasive osteosynthesis technique between Jan 2016 and April 2017 were included in this study. All cases were treated with closed reduction and 4.5mm dynamic compression plate fixation over anterolateral aspect in bridging mode using the MIPO technique. The dominant side, gender ratio, surgery time, radiation exposure, and fracture union time, and complications were noted. The UCLA shoulder and Mayo elbow performance scores were used for assessing the shoulder and elbow function. Results: Out of the ten patients in the study, seven were males and three were females. The mean age was 38 years (range 24 to 60 years). seven out of ten patients (70%) had the dominant side fractured. Mean surgical time in minutes was 80min (range: 60-100 minutes) and mean radiation exposure, in terms of one sec for each c-arm exposure was 88 seconds (range: 60-140 seconds).The mean fracture union (radiological) time was 11.6 weeks (range: 10-18 weeks). However Shoulder function was excellent to good in 9 cases (90%) and fair in 1 case (10%) on the UCLA score. Conclusion: There is high rate of union and excellent functional outcomes by this procedure. Minimal incision with this anterior bridge technique for fracture shaft humerus results in good functional outcomes and should be considered as an effective surgical option in the treatment of humeral shaft fractures. It is a safe and less time consuming method for simple types of humeral shaft fractures when the surgeon is experienced in the technique.
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