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.

No abstract

Tibial plateau fractures are one of the commonest intra articular fractures. Results from indirect coronal or direct axial compressive forces. Among Tibial plateau fractures, Schatzker type V and VI tibial fractures are complex injuries, usually treated with open reduction and internal fixation (ORIF) using LCP plates. AIM: This study was done to determine functional outcome and the complications of Schatzker V and VI tibial plateau fractures treated with LCP plates with a regular follow-up of 18 months. Materials and Methods: Total 30 cases of tibial plateau fracture type V and VI treated with dual plating were studied from FEBRUARY 2017 to NOVEMBER 2018 in Sanjay Gandhi Institute of trauma and orthopaedics, Bangalore. The follow up duration ranged from 6 months to 15 months. The patients were operated through an anterolateral approach for lateral plate and a medial column plate was put through a minimally invasive medial approach or an open posteromedial approach. Results: Total 30 patients were evaluated postoperatively thoroughly for functional and radiological outcomes by Modified Rasmussen Assessment criteria which showed 17 patients (56.7%) had excellent, 8 patients (26.7%) had good,3 patients (10%) had fair and 2 patients (6.7%) had poor outcome Conclusion: We concluded open reduction and internal fixation of high-energy tibial plateau fractures with LCP excellent to good functional outcome with minimal soft tissue complications. Thus, a minimally invasive approach should be used which helps in preventing soft tissue problems and helps in early wound healing. Fixation done by Dual plating is important for early mobilization of knee joint. Early mobilization leads to better range of movements and thereby better functional outcome.

Background: Proximal humerus fractures are common and debilitating injuries and their incidence is increasing especially in elderly. Treatment of unstable, displaced, and comminuted fractures of the proximal humerus remains a challenging issue and significant controversy exists regarding the best method of treating these fractures. Various operative procedures are carried out nowadays, with the recent trend being internal fixation using locking plates. The present study is undertaken to evaluate the functional outcome of proximal humerus fractures treated by proximal humerus internal locking system (PHILOS) plate. Methods: The proposed study is a prospective study conducted between May 2017 to June 2019 in a tertiary care center in Bangalore. In this study 30 post traumatic cases of proximal humeral fractures (Neers type 2, type 3) were treated by ORIF with proximal humerus internal locking system (PHILOS) plate and functional and radiological outcome was assessed using Constant score at 6weeks, 3months, 6months and 1year post-op. Results: Majority of the patients in the study were males (63.3%), RTA being the commonest mode of injury in young population and fall being most common mode in elderly. 11(36.7%) and 19(63.3%) patients had Neers 2 part and 3 part fractures respectively. Radiologically, time to union ranged between 12 to 18 weeks. Mean constant score at one year follow-up was 73.63 and it was found that there was a significant reduction in favorable outcome with increase in age (p< 0.001). Conclusion: PHILOS plating has a good functional outcome for proximal humerus fractures. Accurate anatomical reduction and early fracture fixation are essential for good functional outcome. A proper surgical technique will minimize complications and an aggressive rehabilitation regime will ensure the best possible functional outcome for the patient.

Background: Distal humerus fractures in adults are very difficult and challenging to treat due to intra articular and inter condylar involvement. It accounts for 2% to 6% of all fractures and one third of humerus fractures. The aim of this study was to evaluate the functional outcome of distal humerus fractures treated by bi columnar plating. Materials and Methods: Our study consists of 30 post traumatic distal humerus fracture AO type C3 operated between December 2017 and December 2018. The functional outcome was assessed using The Mayo Elbow Performance Score. Patients were followed up at 6 weeks, 3months, 6months and 1 year post operatively. Results: There were 21(70.0%) male patients, and 9(30%) female patients. Average age of the patients was 39.68 years with age ranging from 18 years to 80 years. 11(36.7%) cases were right humerus and 19(63.3%) were left sided humerus involved. All cases were operated through trans olecranon approach and chevron osteotomy technique, fracture stabilized with bi columnar locking compression plates. At the final follow up most of the patients had excellent postoperative elbow flexion with average arc of elbow flexion of 117.33 degrees, average extension deficit of 8.67 degrees, average pronation of 70.83 degrees, average supination of 70.83 degrees. Conclusions: Bi columnar locking compression plates offer a good fixation for the distal humerus fractures with particular advantage in intra-articular type C3. The device helps in early mobilisation even in fractures with comminution due to its enhanced stability.