Background: US FDA defines non-union as fracture bone that has not completely healed in 9 months since injury and which has not shown any signs of healing over 3 consecutive months on serial x-rays. The operative treatment depends on the type of non-union. There are one-step or two-step procedures according to the principles of the 'diamond concept'. This involves the improvement of the mechanical situation (in most cases with a re osteosynthesis) and vascularization, local application of osteoconductive carriers e.g. tricalcium phosphate, vial cells from autologous bone and osteoinductive substances like bone morphogenic proteins (BMP-2 or BMP-7). Aim: To study the principles and method of fixation of non-union of distal femur with lock plates. Material and Methods: It was a prospective study including patients with non-union of distal femur admitted and examined according to protocol after obtaining informed consent from the patient and permission from the institutional ethics committee. 40 cases satisfying the inclusion criteria admitted in tertiary healthcare centre of Navi Mumbai since May 2018 to March 2020 with minimum 1 year of follow up were included in the study. Results: Patients were also evaluated as per non-union scores. The average non-union score was 19 (range 11 to 27). All of the non-unions united, at an average of 19 weeks. The average arc of knee motion improved from 85° preoperatively to 114° postoperatively. The average Neer's score improved from an average of 60.4 points (range 16 to 44 points) preoperatively to 89 points post operatively. The knee society score (Part 1) improved from an average of 51.87 points (range 36 to 68) preoperatively to 81.725 points (range 74 to 93) post-operatively. Conclusion:The operative technique respecting the biology and biomechanical principles has shown the influence of success of treating these fractures with locking plates.
To decide efficacy of TA vs HA in osteoarthritic patients. Most treatment modalities provide symptomatic relief but intra articular injections with TA and HA probably have the potential of altering the course of the disease. Methods: 60 subjects attending the study scheduled to be given the defined intra articular injection were enrolled as per the study selection criteria. Results: Mean age of cases in TA group was 57 years while it was 58.5 years for cases in HA group (p-0.322). Mean VAS score was comparable between TA and HA group at baseline (p-0.313). After 1 week of intra-articular injection, pain reduction was more in TA group as compared to HA (p<0.05). However, the results were comparable from week 3 onwards (p>0.05). By the end of 1 year, VAS score was comparable to baseline in TA group (p-0.81) while it was still significantly lower than baseline in HA group (p<0.05). Incidence of complications were comparable between two groups with flare ups seen in 13.3% and 6.7% cases of TA and HA group respectively. Acute synovitis developed in 3.3% and 6.7% cases of TA and HA group while 1 case (3.3%) of HA group developed Haemarthrosis. Conclusion:Study shows difference between the 2 intervention groups is the duration of effectiveness. TA mitigates pain faster than HA but the effect of HA is more sustained. Thus HA appears to be superior in duration of pain relief when compared to TA while pain relief is faster with TA.
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