Introduction: Closed fractures of leg are common following RTA, which requires immobilization and leg elevation above heart level to reduce oedema formation and increase of compartment pressure leg elevation is routine in pre operative and post operative period to reduce intra compartment pressure whereas optimum height of elevation has not been standardized till now. Inadvertent elevation of leg decreases venous oedema whereas chances of muscle ischemia increases with prolonged and inappropriate elevation of leg. So determination of appropriate level of leg elevation above heart level by invasive method by white side's method will help reduce muscle ischemia and discomfort to the patient. Purpose: To determine optimum height of leg elevation above heart level to reduce intra compartmental pressure. Methods: Patients at KLES Dr. Prabhakar Kore Hospital with closed fractures of leg. Anterior compartment pressure measured with Whiteside's invasive method .Patients were randomly divided into two groups Group A: 15 cm of leg elevation and Group B:30 cm of leg elevation Results: In this study 60 patients with closed fractures of tibia were selected for intra compartmental pressure monitoring and randomised for different weights of leg elevation i.e., Group A 15 cm above heart level and Group B 30 cm above heart level. The mean age of leg fractures in our study was 40.1 years. Male subjects were 85% (mean = 53) and female were 17% (mean = 7) of total of 60 patients. The measurement of compartment pressure of normal leg was 9.4 ± 2.5 mm Hg. Pressure were measured within 5 cm of fracture site at 0 hr, 12 hr, 24 hr and 48 hr interval using Whiteside's method. The mean values at 0 hr were 29.17 ± 5.95 mm Hg, at 12 hr interval it was 29.97 ± 5.46 mm Hg, at 24 hr interval it was 23.36 ± 3.8 mm Hg and at 48 hr interval it was in Group A. The mean values at 0 hr were 32 ± 7.8 mm Hg, at 12 hr interval it was 32.33 ±57.65 mm Hg, at 24 hr interval it was 26.48 ± 3.5 mm Hg and at 48 hr interval it was in 25.19 ± 2.56 mm Hg in Group B. In our study 5 patients out of 60 underwent fasciotomy. All patients had differential or delta pressure below 30 mm Hg before fasciotomy. Conclusion: Tibia fractures are commonest cause of compartment syndrome of leg. Whiteside's method is a reliable and safe method of measuring intra compartment pressure when sophisticated methods are not available. Inappropriate levels of leg elevation causes muscle ischemia. Elevation of leg to 15 cm leads same clinical results as 30 cm with the advantage of avoiding muscle ischaemia. There is further need for evaluation of different heights of leg elevation and review about our practice of leg elevation.
Spondylolisthesis is the anterior translation of cephalad vertebra, in relation to the adjacent caudal vertebra with an intact neural arch. The majority of low-grade listhesis be treated conservatively in the early stages of the disease. In the end, the problem is further compounded by the development of secondary spinal canal stenosis, which leads to the operating room. Therefore, it is necessary to conduct a study to compare the functional and effectiveness of a decompression, with or without instrumentation, for a low-grade, single-level degenerative spondylolisthesis with canal stenosis. Purpose: The study was carried out to compare the functional and clinical outcome of low-grade degenerative spondylolisthesis with a secondary canal stenosis, with or without the instrument. Methods: 40 patients were enrolled and assigned into instrumented or non-instrumented group, 20 patients in each group. The outcome measures were (1) The visual analogue scale to assess the clinical outcome and (2) the Modified Oswestry Disability Index to assess the functional outcome. Results: The improvement in VAS for low back ache was greater in the instrumented group than in the non-instrumented group (91.3% vs 90.5%) with no significant differences (p <0.001) in between the two groups. The improvement in VAS for radiating pain was greater in the non-instrumented group than in the instrumented group (94.9% vs 89.3%; p <0.001). The improvement in ODI was greater in the instrumented group than in the non-instrumented group (69.5% vs 64.6%; p <0.001). Overall outcome was excellent in 70% in instrumented group compared to 35% in the non-instrumented group Conclusions: Functional outcome is higher in the instrumented group & clinical outcome was better for low back ache for patients who underwent instrumentation & for radiating leg pain for patients who underwent non-instrumented procedure. Longer & larger studies may provide a significant outcome. Based on our results & literature review instrumented group is the superior of the two.
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