Introduction: Low back pain is a problem that is common and its effective management remains a challenge [1] . Major cause of morbidity due to low back pain is prolapsed intervertebral disc which mostly affects young adults in their fourth decade of life. The treatment of lumbar disc herniation remains controversial. Lumbar epidural steroid injection is a reasonable non-surgical option available in lumbar disc disease. Methods: 50 patients attending orthopaedic OPD in HIMS for the treatment of low back ache in the age group 20-70 years and who meet the inclusion criteria were selected for the study. Back pain for atleast six weeks in an adult male/female aged between 20-70 years with evidence of lumbar disc herniation at single level protrusion were included. Results: The patients were followed up for a period of 6 months and were evaluated according VAS scores (visual analogue score) and SLRT (straight leg raising test) taken pre procedure and on follow up visits. Beyond doubt steroid definitely helps control the chemical inflammation causing nerve root irritation which is believed to play a critical role in the genesis of radicular pain with and without the presence of mechanical compression of the nerve roots or cord. VAS score improved [pain relief] in 40 (80%) patients and worsened in 10(20%) patients. Improvement in vas score [pain relief] by 2-4 in around 40 patients (80%) in the initial 2-16 weeks after ESI, at the end of 6 months it showed improvement in 20(40%) patients, remained almost same score 20(40%) patients and worsened in another 10 patients (20%). SLRT was positive in 27(54%) patients, at the end of 6 months SLRT showed improvement in 13(26%) patients, remained same in 12(24%) patients and worsened in 2(4%) patients. Conclusion: Epidural steroid injection probably accelerates pain relief in patients who eventually have natural resolution of radicular pain in a gradual delayed fashion. Epidural steroid could allow faster return to function during the natural history of sciatica.
Ad hoc network nodes cannot be viewed as trustworthy as dedicated infrastructure nodes due to the lack of a maintained infrastructure. As a result, wireless ad hoc networks are subject to a variety of threats that threaten core network functions including routing and packet forwarding. This paper examines the security challenges faced by ad hoc networks and describes the important concerns that must be addressed to achieve ad hoc security. It also provides an overview of major challenges faced by Ad-hoc networks. We discuss the various security attacks and explore approaches to secure the communication.
Background: Distal femur fractures have always posed a challenge to orthopaedic surgeons. Different implants and modalities of fixation have been developed over the years for management of these fractures. The aim of this study was to analyze the complications and clinical outcomes following fixation with LCP as the treatment for distal femoral fractures. Methods: In this prospective study, 30 patients with distal femur fracture were treated using distal femur locking plate at Department of Orthopaedics, Hassan Institute of Medical Sciences, Hassan, during 2017 to 2019. Extra-articular fractures were fixed with minimal invasive technique without exposing the fracture site and intra-articular fractures were treated by open technique. Neer's criteria was used for functional assessment. Results: In our series majority of the patients were males 24(80%), predominantly with AO type C fracture, 26(86.6%). RTA was the major mode of trauma 22(73.3%). Average injury-surgery interval was 3.16 days. Average union time was 17.34 weeks and average range of motion was 102 degrees. According to Neer's criteria 17 patients had excellent results, 6 patients had good results, 3 patients had fair results and 4 patients had poor results.
Conclusions:We conclude that this implant should be used in distal femur fractures especially in, fractures with articular extension and combination. Locking compression plate allows early weight bearing which is an additional advantage for good vocational, mental, social and physical health.
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