<p class="abstract"><strong>Background:</strong> De Quervain’s disease or stenosing tenosynovitis of the first dorsal compartment of the wrist is a common condition, which affects the Abductor pollicis longus and the extensor pollicis brevis tendons. There are characteristic signs and symptoms including a positive Finkelstein's test. Different options for treatment include conservative approaches like analgesics, splinting and physical therapy. If conservative options fail then steroid injection is considered.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective study of single dose intra-sheath triamcinolone and lignocaine injection in 32 patients at our institute who were followed up for a period of 12 months.<strong></strong></p><p class="abstract"><strong>Results:</strong> In our study there were 25 females and 7 males with a mean age of 46.4±8.03 years. Right side was involved in 17 patients and left side in 15 patients. The pre procedure VAS score was 8.65±1.07. The follow up VAS scores at 1, 6 and 12 months respectively were 1.4±1.14, 0.84±1.06 and 1.03±1.26 respectively. 4 out of 32 patients had positive Finkelstein’s test at 1 year follow up. Common complications were pain at injection site, which was seen in 5/32 patients and depigmentation seen in 2/32 patients.</p><p class="abstract"><strong>Conclusions:</strong> Thus intra sheath triamcinolone injection is a safe and effective procedure for treatment of De Quervains disease.</p>

Background:Spondylolisthesis refers to slippage of one vertebra over the other, which may be caused by a variety of reasons such as degenerative, trauma, and isthmic. Surgical management forms the mainstay of treatment to prevent further slip and worsening. However, there is no consensus regarding the best surgical option to treat these patients. This study compares TLIF and instrumented PLF in patients with Grade I and II spondylolisthesis and analysis the outcome with respect to functional outcome, pain, fusion rate, adequacy of medial facetectomy for decompression, and complications.Materials and Methods:Forty patients operated for spondylolisthesis by instrumented posterolateral or transforaminal fusion between January 1, 2010, and June 30, 2012 were included in this retrospective study. They were followed up for 3 years. Twenty one cases were of instrumented posterolateral fusion (PLF) and 19 cases were of transforaminal lumbar interbody fusion (TLIF). The patients were asked to fill up the Oswestry disability index (ODI), Dallas Pain Questionnaire (DPQ), and low back pain rating scale (LBPRS) preoperatively, at 1-month postoperatively, and at 6, 12, 24, and 36 months postoperatively. Radiological parameters were assessed using radiographs.Results:No significant differences were found in DPQ, LBPRS, or ODI scores preoperative, 1-month postoperative, and at 6, 12, 24 and 36 months followup. No significant difference was found between the two groups in blood loss. The only significant difference between the two groups was in the operative time, in which the instrumented PLF group had a mean of 50 min lesser than the TLIF group (P = 0.02).Conclusions:TLIF and instrumented PLF are equally efficacious options in the treatment of Grade I and II spondylolisthesis, except lytic type.

<p class="abstract"><strong>Background:</strong> The study was conducted to analyse the clinical outcomes following a single injection of platelet rich plasma, produced using autologous blood by standard double centrifugation technique in patients with plantar fasciitis who have not had relief using conservative methods.</p><p class="abstract"><strong>Methods:</strong> Between June 2013 and June 2015, 26 consecutive patients (Mean age 45.92) (11 males/15 females) who had symptoms for a minimum of 3 months and had failed conservative management options such as rest, anti-inflammatories and physiotherapy were given a single injection of PRP in the medial calcaneal tubercle.<strong></strong></p><p class="abstract"><strong>Results:</strong> The outcomes were measured using Visual analogue scale and Foot function index at pre injection, and at 1, 6 and 12 months post injection and results tabulated. All patients reported an improvement in VAS and FFI scores consistently. One superficial infection was encountered.</p><p><strong>Conclusions:</strong> Single injection of platelet rich plasma improves pain and function in the foot in patients suffering from plantar fasciitis when conservative management has failed. The synergism between various autologous growth factors may play a role in tendon healing. </p>

No abstract

<p class="abstract"><strong>Background:</strong> Spinal tuberculosis is the most common form of extra pulmonary tuberculosis. Complications of untreated spinal tuberculosis include neurological deficit and gibbus deformity. Treatment of spinal TB can be surgical or conservative. Surgical treatment is the mainstay in spinal tuberculosis with neurological deficit. Various approaches to surgical management are anterior only, combined anterior &amp; posterior and posterior only. Posterior only approach is less traumatic and more familiar to orthopaedicians.</p><p class="abstract"><strong>Methods:</strong> 23 patients diagnosed of spinal tuberculosis with neurological involvement who underwent single stage posterior decompression and posterior stabilization were analyzed with ASIA grading and VAS score..<strong></strong></p><p class="abstract"><strong>Results:</strong> The mean age of the study population was 48.86. There were 12 females and 11 males. The mean operative time and blood loss were 152.19 minutes and 265 ml. Increasing age correlated with blood loss and operating time. The mean follow up period was 36.21 months. There were significant differences in the ASIA and the VAS scores when pre-operative, immediate post-op and final follow up where compared.</p><p><strong>Conclusions:</strong> Single stage posterior decompression and instrumentation is a safe and effective procedure in the treatment of tuberculous spondylodiscitis with neurological deficit and a kyphotic angle &lt;60^o. The long-term results are better because of posterior instrumentation, which provide stability and the healing anteriorly following antituberculous treatment.</p>

<p class="abstract"><strong>Background:</strong> The term intensive care unit (ICU) delirium or ICU psychosis denotes the transient period of psychosis exhibited by the geriatric patients placed in long term ICU care. This condition can be mistaken for organic neurological deterioration and can result in improper treatment, delayed rehabilitation and longer ICU stay. The objective of the study was to analyse the outcome of early ward rehabilitation in post-surgical patients with ICU psychosis.</p><p class="abstract"><strong>Methods:</strong> This is a retrospective case control study of 45 geriatric patients (above 60 years of age) who developed delirium or psychosis after long term ICU stay (&gt;4 days) following a major trauma and orthopaedic procedure. Of the 45 patients, 28 patients (group A) were shifted out of ICU after haemodynamic stability despite continued delirious episodes. The remaining 17 patients (group B) were those who were retained in the ICU for complete neurological recovery.<strong></strong></p><p class="abstract"><strong>Results:</strong> Significant positive difference was noted in patients who were shifted out of ICU early (group A) compared to group B. Group A patients had faster recovery, lesser delirious episodes (2.3±0.9 compared to 13.4±2.7) and fewer days of hospital stay (4.9±1.2 compared to 12.4±2.6) when compared to group B. None of the patients had any episodes of psychosis after discharge from the hospital when followed up for duration of 6 months.</p><p class="abstract"><strong>Conclusions:</strong> Post-operative geriatric patients diagnosed with ICU psychosis fare better with early out of ICU mobilisation. It is not essential to wait for full neurological recovery to shift these patients out of ICU though close ward monitoring may be essential in some cases.</p>

<p class="abstract"><strong>Background:</strong> Vertebral fractures are the most common type of osteoporotic fractures. These are developing into a significant health problem worldwide as about 30% of the patients above 50 years suffer from a fracture secondary to osteoporosis. Osteoporotic vertebral fractures may be treated with rest and analgesics. Some fractures may also require surgery. Percutaneous procedure like vertebroplasty and kyphoplasty done under local anaesthesia can reduce the pain and restore height of vertebral body without need for an open surgery. The aim of the study was to assess the clinical and radiological outcomes following unilateral percutaneous vertebroplasty under local anaesthesia.</p><p class="abstract"><strong>Methods:</strong> 21 patients who underwent unilateral vertebroplasty for symptomatic osteoporotic compression fracture between 2012 and 2015 were included in the study. Unilateral vertebroplasty using an 11-gauge trocar through transpedicular technique was performed under c-arm guidance. Patient was mobilized as soon as tolerated. Oswestry disability index and visual analogue scale were assessed pre-operatively, in the immediate post-op and at 1-year follow up.<strong></strong></p><p class="abstract"><strong>Results:</strong> There were 15 females and 6 males. The mean age was 70.04±6.07 years. The pre-op ODI score was 76.8±7.6. The pre-op VAS score was 7.66±0.71. The average time period from fracture to vertebroplasty is 4.19±3.19 days. The immediate post-operative VAS score was 5.76±0.8 and the ODI score was 62.85±7.17.  The VAS at final follow up was 1.23±1.19. ODI at final follow up was 9.04±3.19. There was a showed a significant improvement when preoperative, immediate post-operative ODI and VAS scores and final follow up (p&lt;0.001).</p><p class="abstract"><strong>Conclusions:</strong> In our study unilateral percutaneous vertebroplasty has provided pain relief, early mobilization of the patient with less complication without the requirement of general anaesthesia.</p>

Introduction: Low back ache is one of the most common causes of physical constraints at work, affecting around 80 percent of the population. Mechanical low back ache and disc prolapse are more seen in younger population while lumbar spinal stenosis and lumbar spondylosis are more common in middle-aged and older patients. The purpose of the study was to determine the short-term functional outcome following Bupivacaine & Triamcinolone through transforaminal route in chronic disc prolapse. Time between onset of symptoms and injection ranged between 2 -12 months. Methodology: A prospective study of 30 patients with chronic low back ache with radiating pain who were well distributed based on age, sex, gender, radiating side and root involved. Patients were treated by transforaminal epidural injection under fluoroscopy guidance with combination of Triamcinolone and bupivacaine. Results: Post injection, functional outcomes were evaluated using VAS, LBPRS and ODI score at 2 weeks, 6 weeks, 3 and 6 months. Conclusion: In our study, there was a statistically significant improvement in the 6-month post TFESI VAS score, ODI score and LBPRS scores compared to the baseline. In conclusion, bupivacaine with triamcinolone is safe and effective in the treatment of chronic disc prolapse patients.