INTRODUCTIONLow back pain (LBP) is a most common problem. Approximately 80% Indian experience LBP during their lifetime. An estimated 15-20% develops protracted pain, and 2-8% has chronic pain. Every year, 3-4% of the population is temporarily disabled, and 1% of the working-age population is disabled totally and permanently because of LBP.1 LBP is second only to the common cold as a cause of lost work time; it is the fifth most frequent cause for hospitalization and the third most common reason to undergo a surgical procedure. LBP is defined as chronic after 3 months because most normal connective tissues heal within 6-12 weeks unless pathoanatomic instability persists. A slowed rate of tissue repair in the relatively avascular intervertebral disc may impair the resolution of chronic LBP. Traumatic or degenerative conditions of the spine are the most common causes of chronic LBP. A number of anatomic structures of the lumbar spine have been considered as the origin of LBP. [2][3][4][5][6] Many studies have shown significant improvement with epidural injections with or without steroids in patients with chronic LBP. Among the multiple interventions used in managing chronic spinal pain; lumbar epidural injections have been used extensively to treat lumbar radicular pain. Epidural steroid injections (ESIs) are a common treatment option for many forms of LBP and leg pain. They have been used for low back problems since ABSTRACT Background: Intervertebral disc herniation, spinal stenosis, intervertebral disc degeneration without disc herniation, and post lumbar surgery syndrome are the most common diagnoses of chronic persistent low back and lower extremity symptoms, resulting in significant economic, societal, and health care impact. Epidural injections are one of the most commonly performed interventions in managing chronic low back pain (LBP) along with surgical intervention. Cost effectiveness and affordability has become the cornerstone of evidence-based medicine, and has an influence on coverage decisions, especially in developing countries such as India. LBP is a common problem. The aim of this study was to find the therapeutic efficacy of epidural steroid injections (ESIs) in chronic LBP. Methods: 50 patients presenting with LBP with or without radiculopathy treated with ESIs were prospectively followed for average duration of 12 months. Results: Fifty patients were included in this study with average age 51.02±7.1, out of these 26 (52%) were males and 24 (48%) females. Significant pain relief (>50%) was demonstrated in 43 (71%) of patients and functional status improvement was demonstrated by a reduction of 40% in Oswestry disability index (ODI) score in 49 (81%) patients. Conclusions: ESIs are very effective and significantly reduce pain in patients with chronic function-limiting LBP.
Introduction: Incidence of fracture of neck of femur is increasing in young adults. Dynamic Hip Screw with a derotation screw or CC screw is used in operation to reduce and stabilize femoral neck fractures. the commonest complications of intracapsular fractures of neck femur are non-union and avascular necrosis. Material And Methods: The study included 40 patients with history of trauma and diagnosed with fracture neck of femur. After thorough evaluation of patient , Pre-operative radiograph of pelvis with both hips were taken. Routine preoperative profile was done in each patient, along with pre-anesthetic check-up. Follow-up X-rays were taken at each follow-up, which were scheduled at 6 weeks, 3 months, 6 months and at 12 months. Functional and radiological outcome were assessed by scoring Modified Harris Hip Score Observation And Results At 12 months: The mean Harris Hip Score in Group 1 was 84.69 ± 4.51 and in Group 2 it was 90.68 ± 2.54. The mean Harris Hip score at 12 months was significantly higher in Group 2 as compared to Group 1 (P=0.001). Conclusion: When it came to treating fractures of the neck of the femur in young adults, our research found that dynamic hip screw fixation performed better than cancellous screw fixation. In terms of functional outcome, the dynamic hip screw had a higher Harris Hip Score and a lower rate of avascular necrosis. Based on the findings of this study, we recommend using a dynamic hip screw rather than a cancellous screw to fix a fracture of the neck of the femur. We recommend larger studies because there is a lack of research comparing these two fixation modalities.
BACKGROUNDTibial pilon fracture though requires operative treatment is difficult to manage. Conventional osteosynthesis is not suitable, because distal tibia is subcutaneous bone with poor vascularity. Closed reduction and Minimally Invasive Plate Osteosynthesis (MIPO) for distal tibia has emerged as an alternative treatment option because it respects fracture biology and haematoma and also provides biomechanically stable construct.The aim of the study is to evaluate the results of minimally invasive plate osteosynthesis using locking plates in treating tibial pilon fractures in terms of fracture union, restoration of ankle function and complications.
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