<p class="abstract"><span lang="EN-IN">With overall prevalence between 2% to 3%, carpal bone fractures are not encountered frequently in clinical practice. Amongst these, pisiform fractures have very low incidence of <0.2%, in which, more than half are associated with other carpal injuries, and sometimes ulnar styloid and ligamentous injuries. Thus, diagnosis of isolated pisiform fracture requires a very high index of suspicion. Hereby, authors report an isolated pisiform fracture in a 27 year old dentist who sustained an injury due to fall on outstretched hand. After radiographic confirmation in multiple views and CT scan, isolated-minimally displaced pisiform fracture was found. A below-elbow cast with slight palmar flexion was given for 4 weeks. He returned to normal pre-injury activities at 12 weeks.</span></p>
Ganglions are the cysts derived from myxomatous degeneration of periarticular tissue, commonly found around wrist and foot. Ganglion cysts are uncommon in Knee region and if present their occurrence is mostly incidental and benign. Based on their location, this could be extraarticular or intraarticular. Lesions with similar pathology in subchondral region around joints are lesser common entity called Intraosseous ganglions. Rarer still is the lesion produced by myxomatous degeneration of periosteum of long bone, called periosteal ganglion. We here present a case of 35 year old Male with gradual onset, poorly localised pain behind left knee which was radiologically suggestive of periosteal ganglion, eroding the posterior aspect of femur and confirmed histopathologically following the excision of a lesion from posterior aspect of femoral condyles.
Introduction: Chronic lumbo-sacral pain is a common and challenging clinical entity in pain management centre. The most commonly involved surgical indication are intractable leg or back pain and significant functional impairment that have been unresponsive to conservative measures. This is a level 2 evidence study where we have studied results of endoscopic discectomy and compared it to conventional discectomy procedure. Material and Methods: We selected 40 patients with severe low back pain radiating to one or both lower limbs, which has failed to resolve after prolonged conservative treatment and have less than level 3 disc prolapse. Oswestry Disability Index (For Low Back Pain) was recorded with questionnaire response and used as clinical tool for assessment. Results: Mean age of 40 patients was found to be 42.9 year with 80% patients having paracentral disc protrusion. Average operative time for endoscopic discectomy was 103 minutes which was higher than conventional discectomy (78 minutes). However, there was minimal blood loss compared to conventional discectomy. Based on ODI score, both endoscopic and conventional discectomy offered similar results in all grades. Conclusion: Endoscopic discectomy is a novel, safe and effective method that minimizes invasiveness of the surgical approach. Results achieved with this method are comparable to those achieved with open discectomy in terms of relief of symptoms on longer follow up, and is significantly better in terms of early mobilisation and morbidity as there is minimal tissue trauma.
Background: Rotator cuff disease is one of the most common condition afflicting shoulder joint. It includes spectrum from minimal bursal/articular inflammation of tendons to severe degenerative cuff tear/arthropathy. With advent in arthroscopic techniques, most RC tears are nowadays treated arthroscopically than open, miniopen or nonoperative management. The purpose of this prospective study is to assess results of arthroscopic repair of rotator cuff tear using UCLA (University of California at Los Angeles) and ASES (American Shoulder and Elbow Surgeons) shoulder scoring systems. Methods: 25 patients operated arthroscopically by single senior arthroscopic surgeon at Civil hospital, Ahmedabad, over a period of 30 months (Dec 2012 to June 2015) were followed for minimum of 12 months duration and included in study. Outcome measures used are preoperative and postoperative UCLA and ASES scores. A proforma was prepared to collect and analyse data using descriptive and inferential statistical methods. Results: In our study, we have measured UCLA and ASES scores over 12 months period. Our study shows improved functional outcome from UCLApresentation-12.2 and ASESpresentation-30.8 to UCLA12 months-30.64 and ASES12 months-77.43. Evident from our study, there is no significant gender difference in terms of incidence and postoperative functional outcome. Maximum incidence is seen in age group-41-50 years with etiological inclination towards precedent trauma. Conclusion: Arthroscopic repair of rotator cuff tear offers excellent functional outcome; with minimal morbidity. Improvement in pain, range of motion and strength of cuff tendons can be achieved only by meticulous repair techniques, adequate subacromial decompression, and strict rehabilitation programme.
Introduction: Medial Gonarthrosis of Knee in middle-aged (40-60yrs) physically active individuals has become a considerable cause for pain, immobility and disability. Varus malalignment at knee joint compromises biomechanics and sets up a vicious cycle which leads to progressive deterioration of medial compartment. Medial open-wedge osteotomy using dynamic external fixator is a recent procedure introduced for axis correction and restoring joint biomechanics with good clinical results. Material and Methods:We retrospectively reviewed 75 patients (78 knees) who were operated for medial compartment arthritis by High Tibial Osteotomy using Hemicallostasis between 2001-2007. Preoperative full length Hip knee axis standing radiographs were taken and femoro-tibial angle determined. Medial open wedge osteotomy using dynamic external fixator was done and axis correction by gradual distraction was achieved to desired angle. Post-operative full length radiographs were compared and evaluated. Oxford Knee Score was used as a clinical tool for assessment. Results: In a mean follow-up period of 83 months, 54% patients showed excellent outcome with improved Oxford knee score. Most significant improvement was observed in females aged 51-60 years. Amongst 75 patients, 11 patients encountered pin-track infection, 4 patients had delayed union, 1 patient had lateral cortical fracture, and 7 patients had knee stiffness. No patients had loss of reduction or nonunion of osteotomy site. No patients had conversion to total knee arthroplasty till last follow-up. Conclusion: High Tibial Osteotomy using dynamic external fixator provides cheap alternative in young active patients with initial stages of Medial Compartment Arthritis with good survivorship, no internal implant, less difficulty in subsequent total knee arthroplasty, minimal scar, minimal tissue disturbance, re-usability of fixator frame and good long-term results.
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