Search

Back ground and objectives: Clavicle fracture accounts for approximately 2.6% of all the skeletal fractures. These fractures are often associated with shoulder girdle injuries in approximately 44% of cases. Non operative treatment has been a mainstay of a modality of treatment, and irrespective of the type of fracture and amount of comminution, all these fractures were treated non-operatively. Different surgical methods for clavicle midshaft fractures have been described and these are locking compression plate fixation, intramedullary K-wires, Steinmann pin fixation, and intramedullary nailing with TENS. Therefore in this study we have compared the functional outcome of displaced clavicle fractures treated by non-surgical management with that of surgical management by TENS and by open reduction and internal fixation with clavicular locking compression plate. Methods: 60 patients with clavicle fractures presenting to the Orthopaedic Department of R L Jalappa hospital from Nov. 2017 to April 2019 are included in the study after obtaining informed consent. Result: Among 60 patients with clavicle fractures, majority of the injury occurred in male patients- 45 cases (75%), whereas a total of 15 cases (25%) were seen in females. The functional outcome at the end of 6 months in 30 conservatively managed cases showed, 4 cases (13.3%) with excellent outcome; 6 cases (20%) had good outcome. 16 cases (53.3%) had fair and 4 cases (13.3%) had poor outcome. While in surgically managed 30 cases, the functional outcome at the end of 6months showed a total of 23(76.6%) cases with excellent outcome, 4 cases (13.3%) had good outcome 2 cases (6.6%) had a fair, and 1 case (3.33%) had poor outcome. At the end of 6 months, functional outcome of both the groups were compared by applying chi square test, the p value was

Introduction: Frozen shoulder” is a chronic condition characterized by gradually progressive, painful restriction of all shoulder joint movement, with slow spontaneous recovery of either partial or complete movement over a period of time. Although many treatment options have been proposed for the frozen shoulder syndrome, each has limitations. Hydro dilation technique was developed in order to loosen the reported contraction and adhesion. we evaluated the Range of movement and pain relief of shoulder following “Hydraulic distension under local anaesthesia along with a steroid” pre and post distension. Material and methods: A prospective observational study was conducted in the department of orthopaedics at RLJ hospital attached to Sri Devaraj Urs Medical College between June 2018 to November 2019 for a period of 1.5 year. All the Patients with Peri arthritis shoulder and age above 30 years were included in the study. After obtaining the informed consent from the patients, Demographic data, History, Clinical Examination and details of investigations were recorded in study proforma. The pain and functional scoring used as per “The society of American Shoulder and elbow surgeons” and follow-up was done at 3 weeks, 6 weeks and 12 weeks after procedure. IBM SPSS version 22 was used for statistical analysis. Results: Total 50 patients were included in the study. The average age of the study population was 52.68 ± 9.79. There were no patients with complete disability. Marked pain (grade 1) was observed on presentation in 46(92%) of the subjects. Post distension only 9(18%) had pain. Flexion, abduction, internal rotation, external rotation movements of the shoulder have improved post distention and were statistically significant at 3rd, 6th, 12 th week. The mean ASES was 36.04 ± 5.84 at base line, it was 67.6 ± 7.64 at 6th week and 91.04 ± 8.68 at 12th week. The differences in the ASES score at 6th week and 12th week follow up period with baseline value were statistically significant (P value

Background: An injury to the anterior cruciate ligament (ACL) is a multifactorial injury and is influenced by intrinsic and extrinsic risk factors. Recently, study of variable anatomy of the proximal tibia has come up as a possible risk factor for an ACL injury. Increased posterior tibial slope (PTS) has been identified as a potential risk factor for anterior cruciate ligament (ACL) injury, but studies which have examined this relationship are inconclusive and sometimes results are contradictory. Methodology: In this study sample size of total 72 patients was included, in which 38 patients had non-contact ACL injury and rest 34 constituted as a control group, who has same demographic characteristics as patients in ACL injury group. This study was conducted in period of April 2017 – Feb 2019 at tertiary care hospital, R.L. Jalappa Hospital, Sduaher, Tamaka, Kolar. All patients included in the study were above 18 years of age and also were willing to participate in the study. Patients with open injury of ipsilateral knee and with previous history of surgery over knee were excluded from the study. The posterior tibial slope was measured from a lateral knee radiograph in all the 72 cases. The data was analyzed for the association between an increased posterior tibial slope and the incidence of ACL injury. Results: In injured group of 38 patients, 15 patients were female and 23 were male. The average age of the patients in this group was 26.7 years (±6.3 years). The control group consisted of 34 patients, in which 24 were men and10 were women. The average age of the control group was 26.2 years (±6.5 years). An ANOVA revealed significant differences in tibial slope angle between the 2 groups. Subjects in the noncontact ACL group had significantly greater tibial slope angles (8.81° ± 2.58°) when compared with control subjects (6.9° ± 2.67°). The trend toward greater tibial slope angles in the noncontact ACL group was also observed when each gender was examined independently; however, the difference was only statistically significant for women between the injury and control groups (8.9° ± 2.6° vs 7.2° ± 2.4°). Conclusion: Our results concluded that, in patients who had non contact ACL injury, had increased posterior tibial slope. But despite of these findings, the clinical significance of an increased tibial slope as an isolated risk factor for ACL injury still remains unanswered. The question also remains as to what degree of increased tibial slope should raise concerns about the increased risk for subsequent injury. Limitations of this study were less number of cases and the study included only non contact ACL injuries. Thus, a study with more number of subjects and also comprising of contact ACL injuries, probably give a better conclusion. Level of evidence: Case-control retrospective study; Level III.

Fractures of the forearm bones may result in severe loss of function unless adequately treated. Severe loss of function may result even though adequate healing of the fracture occurs 1, 4. Fractures of the forearm present a unique management problem for years. A forearm fracture involving both bones requires open anatomical reduction with stable fixation. 2, 3 various treatment modalities were introduced from time to time and each of them had some edge over the previous one. The forearm represents the critical anatomic unit of upper limb, permitting the effector organ of the upper limb, the hand, to perform multiaxial daily activities of living. Historically, the closed management of forearm fractures has been met with frustration in adults and resulted in poor functional outcome, hence perfect fracture reduction and rigid fixation is mandatory and achieved by plating. 3, 5, 7 The number of forearm fractures is increasing faster than the predicted rate due to increasing number of road traffic accidents, increased incidence of violence, rapid industrialization, and various sports activities. Conservative treatment has resulted in malunion, non-union, synostosis and ultimately poor functional outcome 4, 6, 7. compression techniques have a lower incidence of non-union and are found to hasten rehabilitation, with less joint stiffness.the various modalities of plating have developed each has edge over the other. there are very less studies on indian population this study has taken up to analyse the outcome between two most commonly used plates in forearm shaft fracture treatment i.e DCP (dynamic compression plate) and LCP (locking compression plate). Aims and Objectives of The Study: 1) To study and compare the functional and radiological outcome after surgical intervention by using and open reduction and internal fixation with dynamic compression plating vs locking compression plate in the treatment of closed diaphyseal fractures of forearm. 2) To study and compare the complications associated with these two modalities of the treatment. Materials And Methods: About 60 patients with both bone forearm fractures treated with LCP or DCP in RLJ hospital attached to Sri Devaraj Urs Medical College between maech 2013 to june 2017, will be taken up for the study after obtaining the informed consent. This is a retrospective study with follow up period of 6 months minimum. The functional outcome was assesed according to Anderson scoring system which included evaluation of the movements and the radiological union. Conclusions: Statistically, both LCP and DCP have similar outcomes in the treatment of diaphyseal fractures of both bones forearm. Whereas, LCP group had a faster recovery as compared to DCP group. Thus, we conclude that both LCP and DCP have similar results for the diaphyseal fractures.

Plantar fasciitis is the one of the most common causes of painful heel in adults. It is assumed to be caused by inflammation and is typically precipitated by biomechanical stress. Conservative management is the mainstream treatment option for plantar fasciitis like non steroidal anti-inflammatory drugs (NSAIDs), steroid injections, PRP injection, stretching exercises. There is no consensus on the efficacy of any particular conservative treatment regimen. This study was taken with objective to compare the efficacy of NSAID and local steroid injection in treating plantar fasciitis. Method: Sixty patients were randomized into 2 groups, group I patients were treat with oral NSAIDs and group II patients were treated with local steroid injection. Patients of both groups are given common supportive measures such as soft heel and advised same stretching exercises. The patients were evaluated using VAS score for pain assessment at pre-treatment stage, 1 week, 2 weeks, 4 weeks, 2 months and 3 months. Results: 60 patients were randomized into 2 groups, both groups had similar demographics. The VAS scores at pre treatment level in group I was 6.60±1.14 and in group II was 6.46±1.05. The VAS score reduced to 3.10±1.18 in group II after injection and in group I reduced to 4.9±1.33 after a starting oral NSAIDs. The VAS scores consistently reduced in both the groups till 4 weeks of follow up but group II VAS scores were always lower than group I (p-value < 0.001). After 4 weeks, a trend towards increase in VAS scores was noted in both groups, patients had complaints of relapse of pain or increase in intensity of it. Conclusion : With this study we concluded that as compared to NSAIDs the use of local injection of steroid gives better and more sustained pain relief with fewer complications and lesser recurrences of heel pain in cases of plantar fasciitis.

De Quervain’s tenosynovitis is a painful condition of the wrist which leads to difficulties in performing activities of daily living. Aim of the study is to examine the effectiveness of steroid injection therapy as compared to splinting and analgesics for treatment of de Quervain’s tenosynovitis in adults. In (Group 1) the conservative group, patients were advised a splint and NSAIDS. In (Group 2) steroid group, patients were given injection of triamcinolone mixed with 2% xylocaine into the sheath of the affected tendons, under aseptic conditions. We found that steroid injection group showed 83.33% excellent results compared to only 36.67% in conservative group. We conclude that steroid injection is an effective form of conservative management for de Quervain’s disease.

Background: Malleolar injuries are the most common significant lower extremity fractures. These injuries gain importance, because the whole body weight is transmitted through the ankle, and locomotion depends on the stability of the ankle. Open reduction and internal fixation have become the mainstay of treatment for most of the unstable bimalleolar fractures, as these operative methods restores the anatomy, biomechanics and contact loading characteristics of the ankle. Objectives: To study the functional outcome of surgically managed bimalleolar fractures of ankle in adults. Methods: A prospective study of 30 cases of bimalleolar fractures of ankle in adults, managed surgically by various techniques in During the period from December 2014 to May 2016 were studied, satisfying the inclusion and exclusion criteria were studied. The functional outcome was evaluated using the Biard and Jackson’s ankle scoring system. Results: In our study we achieved 86.6% excellent to good results, 6.6% fair results, 6.6% poor results. The results were comparable to other studies. Interpretation & Conclusion: The operative results were satisfactory in 86.6% cases, with good to excellent functional outcome. Excellent results are obtained with stable fixation of fracture. Cancellous screws or malleolar screws are far better in internal fixation of medial malleolus compared to Kirschner -wire fixation and lateral plating was the best for fibular fractures. Good functional results are obtained by surgical management of bimalleolar ankle fractures. Early weight bearing and mobilisation is achieved in these patients. Anatomical reduction with restoration of the articular congruence is essential in all intra articular fractures, more so, if a weight bearing joint like ankle is involved. Open reduction and internal fixation restores the articular congruity of the ankle joint. TBW done for many PER and PA injuries showed promising results comparable to that with screw fixation and also lesser reports of skin irritation at the wound site. It is the method preferred for small transverse fragments and osteoporotic bones of both malleoli especially in the elderly.

Background: Fractures of clavicle are one of the most common fractures in traumatic injury around shoulder girdle as the bone is sub cutaneous throughout. Fractures of middle third clavicle generally occur either by high energy or low energy impact. These fractures have been treated traditionally by non-operative methods. Although many close reduction methods have been described it has been recognised that complete reduction is practically impossible. Open reduction and internal fixation have become the mainstay of treatment for most of the midshaft fractures, as these operative methods restores the anatomy, biomechanics and contact loading characteristics of the clavicle. Objectives: To study the functional outcome of surgically managed clavicle fractures with precontoured locking plate. Methods: A prospective study of 60 cases of midshaft clavicle fractures in adults, Managed surgically by open reduction and fixation with precontoured plate during the period from May 2014 to April 2016 satisfying the inclusion and exclusion criteria were studied. The functional outcome was evaluated using the Constant and Murley scoring system. Results: In our study we achieved 93.4% excellent to good results, 5% fair results, 1.6% Poor results. The results were comparable to other studies. Interpretation & Conclusion: The operative results were satisfactory in 93.4% cases, with good to excellent functional outcome. This study shows rigid fixation with precontoured plate and screws for fresh displaced or comminuted middle third clavicle fracture gives good anatomical reduction, immediate pain relief and prevents the development of shoulder stiffness and non-union and thus on the whole shows good functional outcome by early mobilisation and hence patient to their functional activities.