Sandeep Krishna Avulapati

Abstract

Introduction: Proximal femur fractures in elderly population occur with simple history of slip and fall at home. They are difficult to treat, in presence of comorbidities of patient, osteoporotic and comminuted fracture. Post operatively, mobilization and control of comorbidities are difficult, can result in higher postoperative mortality and morbidity in that group. Aim: To know mortality and morbidity in post-operative proximal femur fracture patients over a period of 3 years. Materials and Methods: Retrospective study included the cases which got admitted and treated during the period of March, 2016 to March 2017. Patient’s details were collected from the medical records section available. Pre and post-operative and present status mobility status were assessed through New Mobility Score. Mortality over three years was calculated. Results: Though 70 patients were included into study, complete data was available for 47 patients. Mobility score which was 7.25 pre-operatively before fall came down to 6.3 (six months) and 5.4 (three years) six months, post-operatively. Out of 47 patients, 12 patients expired at various stages of study. At the end of 3 years of study, mortality rate is 26%. Conclusion: Mortality and morbidity of proximal femur fractures in elderly population is at significant level in India, which needs to be addressed at early stage. Keywords: Mortality, Morbidity, New Mobility Score, Proximal femur fractures, Elderly population.

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Abstract

Osteophytes in knee are a common feature of degenerative osteoarthritis. They do have negative effects like deformities of knee (varus, valgus and fixed flexion deformities), loose bodies (sudden and painful obstruction of knee movements), and pain during movements of knee. They do bring stability to knee by increasing the joint surface area. Here by presenting a case of bilateral osteoarthritis knee, with a large anterior-lateral osteophyte complex, with range of motion 0-90o. Total Knee Replacement surgery was done. Pre, per and post operative period was uneventful, with restoration of normal range of motion 0-900 without any pain. Patient was able to carry-out daily activities of living, thereafter normally. Keywords: Keywords: Bilateral osteoarthritis knee, Osteophytes stabilize, Palpable bony hard swelling.

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Introduction: Much of osteoporosis in India remains Undiagnosed. Forgetting about mortality and morbidity, proximal femur fracture can become an economic and social burden in ageing population in our country. Singh’s Index can be used along with digital X-Ray in evaluation of osteoporosis in proximal femur. This can aid in predicting the type of fracture in elderly individuals. Aim: To evaluate osteoporosis and fracture pattern with Singh’s Index in proximal femur fracture. Null hypothesis: There exists no relationship between grade of osteoporosis (Singh’s Index) and type of fracture in proximal femur fractures. Materials and Methods: A retrospective study was carried out March 2017 to July 2019 in BIRRD (T) Hospital. Patients admitted with proximal femur fractures were evaluated radiological after fulfilling inclusion and exclusion criteria. They were graded with Singh’s Index for osteoporosis and fracture type in proximal femur. Results: A total of 263 patients were included into the study. There were 161 Intertrochanteric fractures, 86 fracture neck of femur and 16 Subtrochanteric fractures in all. There were five grades of Singh’s Index were found from Grade I to V, where Grade VI and VII were not found in the study. Conclusion: Null hypothesis remains rejected. Keywords: Osteoporosis, Singh’s Index, Intertrochanteric fracture, Fracture neck of femur, Subtrochanteric fracture, Proximal femur fractures, Fracture patterns.

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Abstract

Introduction: Periarthritis shoulder is unique condition, in sense that same pathology does not affect any other joints in particular other than shoulder.2 Spontaneous occurrence of pain in shoulder unrelated to injury, but at times associated with injury in 20-30% of cases.2 Main aim of treatment is symptomatic pain relief followed by restoration of normal joint movements. Manipulation under General Anesthesia (MUA) appears to be mainstay of treatment for people who do not benefit by physiotherapy and universal shoulder mobilization exercises.3 Aim of Study: To study effect of manipulation under general anesthesia on Periarthritis shoulder. Objective: To study improvement in Range of Movements, Pain and Short DASH score. Materials and Methods: Study was carried out in Pushpagiri Institute of Medical Sciences and Research Centre during September 2010 to September 2012. 40 patients were selected for the study, underwent MUA with intra-articular steroid injection (40mg/ml methyl prednisolone), 2% Lignocaine (5ml) and Hydrodilation (40ml cold normal saline). They were started physiotherapy immediately and continued. Result: Among the 40 patients 6 patients never returned for follow-up. Data analysis of remaining 34 patients shows improvement in shoulder range of movement. Quick DASH score decreased from 83.72(S.D + 7.1) to 27.66 (S.D + 7.0). VAS score improved from 7.29 (S.D + 1.03) to 1.71 (S.D + 0.84). Conclusion: Periarthritis shoulder, treated with MUA with intra-articular steroid (steroid+Lignocaine) and hydrodilation (with normal saline) result in good immediate pain relief postoperatively and easy breakage of adhesions during the procedure. This followed by immediate physiotherapy decreases pain, adds good functional recovery and early return to daily activities of living. Physiotherapy and universal shoulder mobilization exercises should be continued thereafter to prevent recurrence of symptoms. Keywords: Frozen shoulder syndrome, Adhesive capsulitis, Periarthritis, Manipulation under anaesthesia, Corticosteroids, rehabilitation, Shoulder.

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