Girish Sahni

Abstract

Introduction: Back pain especially in lumbar region has increased to epidemic proportions in general population. It may have associated radiculopathy. Conservative treatment is mainstay treatment for all eviating pain and radiculopathy. A dependable alternative is epidural steroid injection given in multiple doses. Materials and Methods: 50 Patients were treated with caudal epidural steroid injection for chronic low backache of more than three months at our institute. They were evaluated clinically before and after epidural steroid on the basis of pain, unrestricted activities of day to day life and work performance on the basis of visual analogue scale and oswestry disability index. Results: Patients were followed for one year. They were categorized into excellent, good, fair and poor on the basis of pain alleviation and capability to work. We reported excellent 13, good 15, fair 12 and 10 poor results. Three patients required surgery for disc prolapse. Only complication reported was pain at epidural injection region. Conclusion: Epidural steroids are slowly proving to be a reliable alternative for all eviating pain and radiculopathy for a short term. It provides significant symptom free time for patients to receive physiotherapy that is crucial for early and adequate rehabilitation. Keywords: Low back pain caudal epidural injection conservative treatment visual analogue scale.

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Objective: The aim of our study was to evaluate the results of diaphysealtibial fractures, treated with minimally invasive percutaneous plate osteosynthesis without use of the image intensifier, in the terms of rate of union of the fracture, range of motion and rate of complications. Materials and Methods: 30 patients (25 males, 5 females) who were operated upon using the minimally invasive percutaneous plate osteosynthesis (MIPPO) principles without the use of image intensifier for tibial diaphyseal fractures. After indirect reduction, the plate was advanced through a sub muscular extraperiosteal tunnel without opening of the fracture site. The plate was fixed using screws through the incisions made at the proximal and distal ends. Clinical and radiological evaluations were made after surgery. Full weight bearing was allowed after an average of 21.66 weeks. Duration of union and complications were analyzed. Results: The mean duration of union was 19.4 weeks. All cases showed union but malunion occurred in two cases. Conclusion: MIPPO without the use of image intensifier is a very effective alternative treatment for tibial diaphyseal fractures showing high union rates, low complications and no risk of radiation exposure. Keywords: Image intensifier, Biological plate, Fracture, Tibia, Diaphyseal, Malunion, Mesh terms; Tibial fractures, Fracture fixation, Non union, Plate fixation, MIPPO.

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Introduction: Non-union of long bones is a challenging scenario to deal with as management of such fractures is difficult. Tibia is common site of non union.1 Various modes of treatment are available such as ultrasound, electrical stimulation, bone grafting and bone transport by illizarov and rail fixator. We have compared the role of Ilizarov and Rail fixator devices in our study of 15 patients each under both groups. Only Rail fixator had some more patient tolerance as compared to Ilizarov due to problems such as heavy apparatus. Materials and Methods: 15 patients of non union long bones in each group from 21 to 60 years with mean age of 37.6 year in group A and 40.5 years in group B. 90% of the patients were male. Most of the patients had non union of tibia and further the middle one third was more commoly involved in either group. Nine out of 15 patients in both the groups had infected type of non-union. Average shortening was 2.9 cm in group A and 2.86 cm in group B. Maximum number of patients had undergone about two previous surgeries. 12 patients underwent acute docking or compression in group A compared to 13 in group B. Three and two patients underwent compression – distraction for treatment of non union in group A & B respectively. Patients were followed up at 6, 12 and 24 week intervals. Result: In our study union was seen in 13 cases in group A and 14 cases in group B. The duration for union was average 8.8 months and 8.1 months in respective groups. Normal range of motion in nearby joint was achieved in 80% cases. We had excellent to good limb function in 80% of the cases in Group A and 86% of cases as per ASAMI scoring system. Conclusion: Bone results were more or less similar in both the groups. Functional results were a bit better in rail fixator group. Rate of complication were also similar in our study. However patients tolerated rail road with ease and application of rail fixator and comfortable distraction procedure had marginal benefit over Ilizarov. Keywords: Ilizarov, Rail fixator, Non union , Long bones, Infection, Tibia.

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Introduction: To study the role of proximal trochanteric contoured plate in management of complex proximal femur end fractures. Materials and Methods: A total of 30 cases 11 male and 19 female patients aged 19 to 90 years [Mean age 42] were included. Time duration of surgery, total amount of blood loss, hospital stay, mobilization and weight bearing, radiological assessment of union, complications and Harris Hip score were assessed at the end of 6 months. Results: Mean duration of surgery was 72.18 mins, average blood loss was 283.75ml, average hospital stay was 13.75 days. Mean time for radiological union was 16.8 wks and Harris hip score was 84.6. Abductor lurch occurred in 4 cases. Conclusion: Proximal Femoral Locking Compression Plate (PFLCP) provides stable fixation for fractures of proximal end of femur especially for lateral wall fracture because it provides stable fixation of lateral fragments and prevents lateral migration of proximal fragments. Keywords: Proximal femur fractures, Proximal femur locking plate, Harris Hip Score. MESH words: Proximal femur fracture, Internal fixation, Extramedullary devices

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