Indian Journal of Public Health Research & Development

Vineet Pruthi ¹, Ashwani Ummat ², Manjeet Singh ³, Sonia Kochhar ⁴, Subodh Pathak ⁵, Vishesh Verma ¹, Aryan Sharma ¹

Affiliations
1 PG Resident MS Orthopaedics, Maharishi Markandeshwar Deemed to be University, Mullana, Ambala, IN
2 Professor Department of Orthopaedics, Maharishi Markandeshwar Deemed to be University, Mullana, Ambala, IN
3 Professor and Head, Department of Orthopaedics, Maharishi Markandeshwar Deemed to be University, Mullana, Ambala, IN
4 Associate. Professor, Department of Physiology, AIIMS, Bathinda5, IN
5 Assistant Professor, Department of Orthopaedics, Maharishi Markandeshwar Deemed to be University, Mullana, Ambala, IN

Abstract

Introduction: In cases of infected Nonunion of long bones Antibiotic coated nail provides mechanical support for the affected bone with delivery of high concentration of antibiotics for infection control and a conclusive environment for fracture healing. The aim of the study was to observe and study the treatment of infected non-union of long bones with antibiotic coated nailing in infection control and bony union. Material and Method: The study was conducted on 30 patients (male and female between the age of 18‑70 years). All patient on admission were subjected to detailed history, relevant investigations and thorough clinical examinations. Minimum follow-up period was 6 months. Radiological and blood investigations were done for infection control and bony union. Result: In the current study of 30 patients with mean age of 43.67 years, Infection control and bony union was achieved in 27 patients without any need for subsequent procedures. Current study provides an alternative to external fixation alone as a means of stabilizing non-unions while providing a high concentration of antibiotic locally for combating this difficult problem. Conclusion: The clinical results and final outcome after antibiotic coated I.M. nailing in infected nonunion of long bones are both satisfactory and reproducible as evident by the comparison of this present study with the previous literature available.

Keywords

Infected nonunion, antibiotic coated nail.

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Manjeet Singh ¹, Ashwani Ummat ², Vishesh Verma ³, Praveen Thivari ³, Harsimarjit Kaur ⁴

Affiliations
1 HOD, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, IN
2 Professor, Deptt. Orthopedics, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, IN
3 PG Resident M/S Orthopaedics, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, IN
4 Associate Professor, Deptt. Anatomy, Government Medical College and Hospital, Patiala, IN

Abstract

Introduction: Tranexamic Acid has been used in major surgeries in various fields of medicine. It has shown to effective in reducing the blood loss during surgery. But it’s use in orthopaedic surgeries was limited due to concern regarding efficacy and safety. Material and Method: 54 patients were included in the study during the study period. Patients were randomly allotted to 2 groups of equal participants. The first group (Group A) received Tranexamic Acid. The second group (Group B) was given placebo. The Total Blood Loss and Fall in Haemoglobin levels were measured post-operatively at 24 and 72 hrs of post-operative period. Result: The group A had showed significantly reduced total blood loss and fall in Haemoglobin, thus, requiring less blood transfusions. No complications were noted with tranexamic acid use. Conclusion: We conclude that Tranexamic acid can be effective in reducing blood loss and subsequent fall in haemoglobin. Its judicious use may thus reduce allogenic blood transfusions in major orthopaedic surgeries.

Keywords

TRAMOS, Tranexamic acid, Bleeding, Major Orthopaedic surgeries

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Manjeet Singh ¹, Harish V.K. Ratna ², Harish V.K. Ratna ², Ashwani Ummat ³, Ashwani Ummat ³, Jasneet Chawla ², Jasneet Chawla ², Harsimarjit Kaur ⁴, Harsimarjit Kaur ⁴, Vishesh Verma ², Vishesh Verma ²

Affiliations
1 Professor and HOD, Department of Orthopedics, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, IN
2 Postgraduate Resident M.S. Orthopedics, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, IN
3 Professor, Department of Orthopedics, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, IN
4 Associate Professor, Deptt. Anatomy, Government Medical College and Hospital, Patiala, IN

Abstract

Introduction: The Tendo-achilles, also known as the calcaneal tendon is a strong fibrous tissue structure that connects muscles of the calf to the heel (calcaneus). The calf muscles-gastrocnemius and the soleus muscle along with the plantaris muscle, unites into a strip of tissue and becomes the Tendo-achilles at the lower end of the calf and acts as a main flexor of the ankle joint. The Achilles tendon rupture is considered to be chronic if the injury is past 4-6weeks of duration. Materials and Method: From May 2016 to May 2018, 15 Patients with long-standing rupture of the Achilles tendon were treated with the operative technique mentioned below, in MMDU, Mullana, Ambala. All the patients gave informed consent prior to being included in the study. Results All patients were evaluated according to The American Orthopedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score. 8 patients had excellent results, 4 patients had good results, 2 had fair results and 1 patient had poor result. All patients resumed work at 6 months postoperatively. Conclusion: Our technique is ideally suitable for chronic ruptures in zone I (where there is no distal stump available for repair) and ruptures that have a large gap of more than 5-6 cms. This is accomplished with a single long incision, with a good post-operative range of ankle motion and function and no major post op complications.

Keywords

Chronic TA Rupture, Modified Bosworth Technique, Zone 1 Ruptures.

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Vishesh Verma ¹, Manjeet Singh ², Ashwani Ummat ³, Praveen Thivari ¹, Harsimarjit Kaur ⁴, Jasneet Chawla ¹, Vineet Pruthi ¹

Affiliations
1 P.G. Resident M/S Orthopaedics, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, IN
2 HOD Department Orthopaedics, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, IN
3 Professor Department Orthopaedics, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, IN
4 Associate Professor, Deptt. Anatomy, Government Medical College and Hospital, Patiala, IN

Abstract

Introduction: Proximal Fibular Osteotomy (PFO) is removing 1-1.5 cm of FIBULA, 7 to 10 cm below its head, which provides symptomatic relief from pain of medial compartment Osteoarthritis (OA) knee. It is a procedure wherein we remove Proximal part of fibula to stop mechanical axis of knee going into further varus and hence putting a stop to progression of disease. The aim of the study was to observe and study the resultsin patients of isolated medial compartment Osteoarthritis of Knee,treated by Proximal Fibular Osteotomy. Material and Method: The study was conducted on 36 patients amounting to 50 knee joints (male and female between the age of 50-70 years) with medial compartment OA Knee. Patients were followed up till 6 months. Medial and lateral joint space along-with visual analogue score for pain were recorded preoperative, immediate post-operative and at final follow up. Result: Significant improvement in mean visual analogue pain score (VAS), from 7.32 + 0.98 preoperative to 2.72 + 1.20 at the final follow up was observed (p-value <0.001). Medial joint space opening from 1.17 + 0.29 to 4.07 + 0.69 at final follow up was observed. American knee society score was divided into 2 subsets, knee score and functional score. Both of them showed significant improvements from 39.72 + 3.47 and 44.20 + 8.47 (pre-operative) to 86.58 + 10.79 and 84.60 + 8.38 respectively, at final follow up (p-value < 0.001). Conclusion: The objective as well as functional outcome after proximal fibular osteotomy were satisfactory. With correct patient selection and meticulous adherence to basics, Proximal fibular osteotomy offers an excellent alternative to tedious and extensive procedures like High tibial osteotomy (HTO) and Unicompartmental Knee Arthroplasty (UKA). It is specially enthralling in country like ours where everyone cannot afford expensive surgeries and are forced to live a life of misery and morbidity.

Keywords

Medial compartment Osteoarthritis Knee, PFO, American Knee Society Score, Fibular osteotomy.

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Jasneet S. Chawla ¹, Manjeet Singh ², Ashwani Ummat ³, Manu Goyal ⁴, Harsimarjit Kaur ⁵, Vishesh Verma ⁶

Affiliations
1 P.G. Resident M/S Orthopedics, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, IN
2 HOD Department Orthopedics, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, IN
3 Professor Department Orthopedics, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, IN
4 Associate Professor, Department of Physiotherapy, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, IN
5 Associate Professor, Deptt. Anatomy, Government Medical College and Hospital, Patiala, IN
6 P.G. Resident M/S Orthopedics, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, IN

Abstract

Introduction: Plantar fasciitis or calcaneus pain syndrome is the inflammation of origin of plantar fascia and the nearby perifascial structures which is attached to the medial process of the calcaneal tuberosity Histology suggests mainly degeneration rather than inflammation but fasciitis still remains more prominent in the literature. The windlass mechanism describes the biomechanics associated with plantar fascia. Material and Method: This study included 60 patients who were divided into 2 randomized selected groups on the basis of arrival. 30(even) patients were made to do calf stretching exercises and 30(odd) did plantar fascia stretching exercises. The stretches mainly included 8 repetitions, 20 seconds each, 2 times a day and 3 times a week for a duration of 4 weeks. Data was collected and described by using independent t-test and Repeated Analysis of variance was also used. Results: Maximum number of patients who had plantar fasciitis were in the age group 41-50 (36.6%). Both the stretching exercises were assessed with VAS, FFI and AOFAS at day 0 and every follow up i.e 1^st week, 2^nd week and at the end of 4^th week which showed more improvement and better satisfactory outcome in plantar fascia stretching exercises than the calf stretching exercises. Range of motion showed more improvement with calf stretching exercises. Conclusion: This study promotes the use of the tissue-specific plantar fascia-stretching protocol as the key exercise. Long-term benefits of the stretching includes a marked decrease in pain and high rate of satisfaction. This approach provides the health-care practitioner with an effective, non-invasive, inexpensive and straightforward treatment protocol.

Keywords

Plantar Fasciitis, Calf Stretching Exercises, Plantar Fascia Stretching Exercises

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Ashwani Ummat ¹, Manjeet Singh ², Manjeet Singh ², Sarthak Sharma ³, Sarthak Sharma ³, Praveen Thivari ³, Praveen Thivari ³, Vishesh Verma ³, Vishesh Verma ³, Jasneet Chawla ⁴, Jasneet Chawla ⁴

Affiliations
1 Professor Department of Orthopaedics, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, IN
2 HOD and Professor Department of Orthopaedics, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, IN
3 PG Resident M/S Orthopaedics, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, IN
4 Postgraduate Resident M.S. Orthopedics, Maharishi Markandeshwar (Deemed to be University), Mullana, Ambala, IN

Abstract

Introduction: Sciatica is one of the most excruciating type of pain resulting due to irritation of the sciatic nerve in the lower back. Pain radiates along the distribution of the sciatic nerve in the lower limb. Lumbar disc herniation is commonly implicated as a cause of sciatica. Treatment options include initial conservative approach with epidural injection and analgesics and in patients with no relief decompression surgery performed. The short-term efficacy of the epidural injections is well established but the long-term outcome remains controversial. Even, spinal decompression surgeries have shown significant relief of symptoms at short term but in long term remain doubtful. This study attempts to compare both these treatment options in people with disabling chronic sciatic pain. Materials and Method: This prospective randomized controlled trial conducted on 25 patients for duration of 1 year with sciatica symptoms lasting for more than 6 weeks. Complete history and examination with imaging studies was carried out with pain assessment done by using a Roland Disability Questionnaire (RDQ) and Visual Analogue Scale (VAS). Follow up Assessment of the patient’s were done at regular interval of 0, 2, 4, 12, 26, 52 weeks post intervention. Results: Of the 25 patients 12 were assigned randomly to early surgery group and 13 to epidural injection group. Immediate post-op and follow up assessment showed significant improvement in pain and disability scores for patients randomized to early surgery group with a significant difference between areas under the curve. The short-term benefit of early surgery was no longer significant by 6 months and by the end of 1 year outcomes were similar between the two groups. Conclusion: Early surgery achieved more rapid relief of sciatica than conservative care, but outcomes were similar by one year in patients of both groups.

Keywords

Decompression Surgery, Lumbar Disc Herniation, Sciatica, VAS.

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