Introduction: Pain management in total knee arthroplasty is aimed to minimize postoperative pain and improve functional outcomes in patients. Although there are many methods used for controlling the pain there has been no consensus on most appropriate or the best protocol. Adductor canal block (ACB) has the unique advantage of providing localized analgesia but it doesn't provide pain relief to the posterior capsule, it has been postulated that IPACK (interspace between the popliteal artery and the capsule of the knee) combined with ACB will provide better pain relief than ACB alone. Materials and Methods: 60 Patients were studied in two groups. Group A had those patients with ACB+ ipack and Group B had ACB. Group A -Patient were subjected to combined ACB block with IPACK. Group B -Patient in this group were given ACB. Patient were studied for pain score VAS on Day 0 and Day 1 morning and evening, range of movement at postoperative Day 1 and distance walked on Day 1. Results: Group B had better outcome as compared to Group A. The mean VAS score for the ACB+IPACK group was less than for ACB alone at end of Day 0 and Day 1 in morning and evening. The ROM for the ACB+IPACK group was better than ACB alone and number of steps walked by patients were more in ACB+IPACK as compared to ACB alone. The statistical difference was significant when Adductor +IPACK group was compared to Adductor group for VAS, ROM and number of steps walked. Conclusion: ACB+IPACK is better mode than ACB for control of postoperative pain in patient undergoing Total knee replacement. IPACK is relatively safe and combined with adductor canal block decreases posterior pain in TKR patients.
Background: Proximal Femoral Nail (PFN) provides tangible evidence for its usage in unstable pertrochanteric fractures. There are a veritable number of references which show that PFN by virtue of its intramedullary fixation reduces the tensile strain thereby mitigating implant failure. Ours is a prospective study done on 50 subjects to assess the outcome of PFN usage in unstable pertrochanteric fractures. Methodology: 50 patients with Jensen Michaelsen type III, IV, V intertrochanteric and reverse oblique fractures were included in the study. The reduction obtained intra operatively was assessed using the modified criteria of Baumgaertner. Follow up evaluations were done at 6, 12, 24 and 52 weeks thereafter. Clinical evaluation was done using the Mobility score of Parker and Palmer. Radiographic parameters like fracture union, screw slide and degree of varus collapse were also assessed. Statistical analysis was provided by Friedman test. Results: Jensen Michaelsen type IV was the most common pattern observed (44%). The mean pre-injury parker score was 8.4. Patients with reverse oblique fracture morphology, type V fractures and patients with osteoporosis were treated with Long PFN (19 cases). The mean operating time was 92 minutes (range 60 -180), and the mean blood loss during the surgery was 145 ml (range 100ml -320 ml). The reduction was good in 40 patients (80%) and acceptable in the rest. The average time taken for fracture union was 15 weeks. It was observed that patients reached their preoperative mobility score of Parker and Palmer by 6 months post-surgery which was statistically significant (χ2 = 217.642, p < .001). Discussion: Proximal Femoral Nailing is done through a minimally invasive approach not disturbing the fracture hematoma which is a vital in fracture consolidation. The biomechanics of intramedullary fixation in cases of destabilised medial cortex is optimised by medialization of the fulcrum point and resultant reduction of the bending moment with respect to proximal fixation. Fracture reduction was good in 80% cases and in 10 cases the reduction was acceptable with a mean varus malalignment of 13.2 degrees.The mean intraoperative blood loss of 145 ml in our series compares favourably with previously reported values in the literature. Most of the fractures in our series (66%) united by 12-14 weeks. The mean preoperative mobility score of Parker was 8.4, which was reached by patients on their 6 th postoperative month (p & lt; 0.001). Each period showed statistically significant improvement over the previous period as evident from the rank total of the scores and the critical ratio.
With the dynamic success of intramedullary fixation of fractures of the femur and tibia, there was speculation ABSTRACT Background: Humeral shaft includes 1% of all fractures. The advantage of operative management is early mobilization and patients comfort. Most of the studies compare two main modalities of management, 1. dynamic compression plate 2. intramedulary interlocking nail, with respect to fracture union as major criteria. Very few studies have compared functional outcome with respect to shoulder and elbow joint. The purpose of this study is to compare the outcomes of each method of fixation. (Dynamic compression plating and interlocking nailing) for the fracture shaft of humerus and to analyse statistically significant difference in the results of these two methods. Methods: There were 58 patients of fracture shaft humerus were enrolled during 2 May 2015 to 2 January 2017 in the study. They were randomly divided into two groups, DCP group and IMILN group, each having 29 patients and compare the functional outcome of both groups with each other. Results: There were total 53 patients among them 26 (49.05%) treated with DCP and 27 (55.95%) treated with intramedullary interlocking nail (IMILN).The mean age of patient treated with DCP was 40.12 years (SD±8.51, Min-Max: 25-60) and treated with IMILN was 41.96 years (SD±11.04, Min-Max: 22-61). Road traffic accident was major mode of injury to shaft of humerus. Conclusions: Dynamic compression plating is preferable technique than interlocking nailing for fracture shaft of humerus in adults.
Introduction: Number of operative techniques have been described with the use of lag screws, steel wires, arthroscopic tight rope fixation, arthroscopic suture bridge technique. As there is continuous advancement in newer technique, we are comparing outcome of PCL tibial avulsion fixed by two different methods open reduction internal fixation by CC screw and arthroscopic suture bridge technique. Method: The PCL tibial avulsion was approached by posterior Burks and Schaffer approach, fixed by CC screw in half of the patient and in another half, we used arthroscopic suture bridge technique. One fiber wire is used in arthroscopic technique. Results: Anatomical reduction and fixation of PCL avulsion by arthroscopic fixation is equally effective when compared with ORIF by CC screw fixation. Conclusion:The use of CC screw could be a simple and reliable technique for PCL avulsion fractures of the tibia. Patients achieved good knee function after surgery, but arthroscopic suture bridge technique of PCL avulsion fixation gives better knee function and less intraoperative complications.
This is very common injury faced by Orthopaedic surgeons. It accounts 15-16% of the total percentage trauma. The restoration of normal congruency of distal radius is essential, otherwise the secondary osteoarthritis of wrist joint sets in at a faster pace. The modalities of treatment available are a) Closed reduction, b) crossed K-wires, c) External fixator, d) volar locking compression plate. There are various parameters to assess the displacement which are a) ulnar variance, b) radial length, c) radial inclination, d) palmar tilt, e) dorsal angle. The results of fixation depend entirely on all these factors aforementioned, which can judge whether the normal anatomy of the joint is restored.
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