Background:Fluorosis is an endemic disease of India which causes compressive cervical and/or dorsal myelopathy. This study aims to evaluate the role of surgical management in the crippling fluorosis along with evaluation of radiological imaging as screening/diagnosing tool for the disease.Materials and Methods:This is a prospective cohort study of 33 patients operated at tertiary care center having nontraumatic involvement of spinal cord affecting neurology with history, clinical and radiological features (Ossified Posterior Longitudinal Ligament-, Ossified Ligamentum flavum) suggesting fluorosis as the cause of compression. Outcomes were measured in terms of improvement in Nurick grading, Rankins scale, spasticity, Oswestry Disability Index, modified Japanese Orthopaedic Association scores.Results:Spinal fluorosis is a male predominant disease affecting the elderly after years of fluorine intake. Cervical and/or dorsal spine are predominantly involved at multiple levels (>=2). Diagnosis of the disease poses difficulty due to lack of established laboratory parameters with high sensitivity, availability, and lack of awareness among surgeons. Skeletal survey alone has >90% sensitivity for diagnosing the disease. Once evaluated properly, decompression at correctly identified levels invariably improves the spasticity and quality of life immediately post-surgery. At final followup, there was on average improvement of 2 scales in nurick grade, rankins scale and ashworth grading whereas average improvement in ODI, mJOA and dorsal specific mJOA were 52%, 3.17 points and 2.7 points respectively. However, preoperative counselling for “apparent neurological deterioration” in immediate postoperative period is very important. Complications like infection and dural tear have to be prevented with special surgical tactics.Conclusion:Skeletal survey along with computed tomography and magnetic resonance imaging is cost-effective modality for the screening/diagnosis for fluorosis. Once developed, surgery, either curative or palliative, is the best treatment at crippling stage of the disease.
The clavicle is easily fractured because of its subcutaneous, relatively anterior location and frequent exposure to transmitted forces. The middle third, or midshaft, is the thinnest, least medullous area of the clavicle, and thus the most easily fractured; the lack of muscular and ligamentous support makes it vulnerable to injury. It is often caused by a fall onto a shoulder, outstretched arm, or direct trauma. The fracture can also occur in a baby during childbirth. The anatomic site of the fracture is typically described using the Allman classification, Group I (midshaft) fractures occur on the middle third of the clavicle, group II fractures on the lateral (distal) third, and group III fractures on the medial (proximal) third.
Introduction: Osteoarthritis of the knee is one of the most common causes of disability among elderly population. OA clinically presents as flexion with varus deformity. Various methods to manage bone defects during TKR surgery have been described like use of Bone cement, Bone grafts, metal wedges and augment and Extension of tibial stem in various permutations and combinations. In this study we are evaluating the results of tibial bone defect. Aims and Objectives:To study the Result of Tibial defect in TKR managed with Bone cuts and Cement Materials and Methods: A Prospective study of 55 total knee replacements performed over 42 patients for osteoarthritis knee by trained surgeons at a tertiary care centre in the Department of Orthopaedics, BJ medical college, Civil hospital Ahmedabad between May 2019 to September 2021. The mean follow-up study time was 3 years. Observation and Results: All the operated patients were followed up for mean period of 3 years. The defects in our study were solely managed with bone cuts and cement with or without screw augmentation. Conclusion: Tibial bone defect even more than 5 mm but less than 10 mm can be effectively managed with bone cuts and cement alone or screw fixation without any bone grafts or tibial augmentation.
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