MATERIALS AND METHODS: Medical records and relevant radiographs for each patient were analysed and collected from the time of presentation till the point of latest follow-up. During each clinic visit, all physical exam findings as well as all complications were recorded. The American Foot and Ankle Society (AOFAS) Hindfoot score was also tabulated for each patient at the point of latest review.
RESULTS: Closed reduction was unsuccessful in all three patients, and all required open reduction. One patient had an uncomplicated recovery whilst the remaining two suffered significant soft tissue complications. One patient suffered severe soft tissue swelling preventing primary closure at the time of surgery, whilst another suffered post-operative wound dehiscence and infection. Eventually all fractures healed, and all three patients obtained satisfactory AOFAS scores.
CONCLUSION: The diagnosis of Bosworth fracture dislocations of the ankle is often delayed or missed, due to its rare occurrence. Closed reduction is often unsuccessful, and early open reduction is required to avoid poor clinical outcomes due to severe soft tissue damage or even compartment syndrome.
MATERIALS AND METHODS: Retrospectively, we reviewed nine cases of glomus tumour. A clinical evaluation proforma was developed on the basis of clinical history and specific clinical test for diagnosis of these tumours. All the cases were evaluated and treated surgically by a single surgeon with a specific technique. Post-operatively, diagnosis was confirmed by histopathological examination.
RESULTS: Females (77.78%) were predominantly affected in this series and the tumours commonly occurred in the right hand (66.66%). Spontaneous pain, cold sensitivity test and Love's Pin test was positive in all cases (100%). Hildreth's test was positive in 88.89%. In none of the cases the tumours recurred during minimum follow-up of one year. In all cases, histopathological examination confirmed the preoperative diagnosis of glomus tumours.
CONCLUSION: Diagnosis of glomus tumours can be made clinically based on history taking and clinical examination. Magnetic Resonance Imaging and Ultrasound are not necessary for diagnosis and management of typical subungual tumours.
Material and Methods: The present investigation is a prospective randomised controlled open label study, performed at our Hand Surgery Department (Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome) from October 2018 to March 2019. The enrolled patients were divided in two groups: Group A (ALA-R 600mg once day for 60 days) and Group B (control Group, no drug administration).
Results: 134 patients (74 F, 60 M) met the inclusion and exclusion criteria. In Group A, there was a statistically significant pain reduction compared to the control Group. Using the Boston Carpal Tunnel Questionnaire, there were no significant improvements in the other symptoms and function.
Conclusion: ALA-R full dose administration for two months leads to positive short term results in terms of symptoms and function improvement, even if the surgical carpal tunnel release remains the treatment of choice.
METHODOLOGY: This cross sectional study on tibiofemoral angle was conducted among 160 normal healthy children using clinical measurement method. The children between 2 18 months to 6 years old were assigned to 5 specific age groups of 32 children with equal sex distribution.
RESULT: This study had shown a good inter-observer reliability of tibiofemoral angle measurement with intraclass correlation coefficient (ICC) of 0.87 with narrow margin of 95% confident interval (95% CI: 0.73, 0.94). The mean tibiofemoral angle for children at 2 , 3 , 4 , 5 and 6 years old were 2.25° (SD=0.53), 8.73° (SD=0.95), 7.53° (SD=1.40), 7.27° (SD=1.14) and 6.72° (SD=0.98) respectively. The age when they achieved maximum valgus tibiofemoral angle was 3 years old. The maximum mean (SD) tibiofemoral angle for boys, girls and all children were 8.91° (SD=1.17), 8.56° (SD=0.62) and 8.73° (SD=0.95)respectively. The mean tibiofemoral angle showed no statistically significant difference between girls and boys except for the 5-year-old group, in which the mean TF angle for girls was 7.560 (SD=0.95) and for the boys was 6.970 (SD=1.26) with p-value of 0.037.
CONCLUSION: Measurement of tibiofemoral angle using the clinical method had a very good inter-observer reliability. The tibiofemoral angle in Malay population was valgus since the age of 2 years with maximum angle of 8.730 (SD=0.95) achieved at the age of 3 years.
MATERIALS AND METHODS: In a randomised controlled trial, patients received short-segment fixation with intermediate screws. We assessed post-operative back pain (Visual Analog Scale or VAS), blood loss, operative/fluoroscopy times, radiographic parameters, and oswestry disability index (ODI) scores at 1, 2, 3, 6, 9, and 12 months.
RESULTS: Between January 2018 and October 2019, 31 patients received PPSF and 30 OPSF. Mean intra-operative blood loss was 66.45 (±44.29) ml for PPSF vs 184.83 (±128.36) ml for OPSF (p<0.001). Fluoroscopy time averaged 2.36 (±0.76) minutes for PPSF vs 0.58 (±0.51) minutes for OPSF (p<0.001). No significant differences existed in operative time or post-operative VAS scores. Radiographic parameters (kyphosis angle and vertebral height ratios) didn't significantly differ post-operatively or at 12 months. However, ODI scores differed significantly at 6 months (p=0.025), with no difference at 12 months.
CONCLUSION: In this trial, PPSF was comparable to OPSF in improving ODI scores at 12 months but showed earlier improvement at 6 months and reduced blood loss. Radiographic outcomes remained similar between groups over 12 months.
Materials and Methods: Fifteen patients with malunited intertrochanteric fractures who presented between January 2011 to January 2013 were managed by Valgus osteotomy with DHS fixation and were followed-up for a minimum period of three years.
Results: There was a male preponderance seen in our study with the right hip being more commonly affected. The most common mode of injury was slip and fall followed by road traffic accidents. The duration of native treatment ranged from seven to 12 weeks and the time of presentation to the hospital ranged from four to nine months following injury. Pre-operative mean neck shaft angle was 94.73° while it was 134.6° post-operatively. The mean pre-operative Harris hip score was 72.33 and it was 91 at follow-up. All patients were happy with the procedure and the functional outcome.
Conclusion: Valgus osteotomy with DHS fixation is an effective procedure in the management of malunited intertrochanteric fractures. It corrects the limb length discrepancy, restores the decreased neck shaft angle, improves range of movement, restores the integrity of the abductor mechanism of the hip and gives good functional results.
Materials and Methods: A total of 30 patients with type V and VI proximal tibial fractures who presented between January 2012 to January 2015 were managed with hybrid external fixation and were followed-up for a period of 3 years.
Results: The mean age of the patients was 42.26 years with the left knee being more commonly affected. Schatzkers type V was the more common fracture type seen. The mean time to union was 12.06 weeks and the average range of motion achieved was 0 to 100°. The mean Rasmussens functional score was 25.4 at last follow-up and we had excellent results in 5 patients and good results in 22 patients.
Conclusion: Through this study, we conclude that the hybrid external fixation is an excellent option in the type V and VI fractures with extensive soft tissue compromise. It is easy to apply, facilitates early mobilisation of the joint and gives good functional results.
OBJECTIVE: To determine whether repetitive tasks performed for long hours by computer operators can lead to peripheral neuropathy as measured by nerve conduction studies of upper extremities.
MATERIAL AND METHODS: We performed nerve conduction tests on 50 computer operators in two study groups. Group I consisted of computer operators who worked a minimum of 6 hours per day at the computer while Group II worked a maximum of 2 hours per day.
RESULTS: Significant differences were observed between groups for most physical signs. In addition, there were significant differences between the groups for nerve conduction velocities of the medial (motor & sensory) and ulnar (motor & sensory) nerves.
CONCLUSION: We found symptoms of pain, paraesthesia and subjective weaknesses as well as decreased conduction velocities of peripheral nerves in computer operators who work long hours. Further nerve conduction studies are needed to confirm predictive value for the development of carpal tunnel syndrome.
KEY WORDS: computer operator, long work hours, nerve conduction studies.
METHODS: Forty-one patients above 60 years of age and an acute displaced fracture of the femoral neck were randomly allocated to treatment by either unipolar or bipolar hemiarthroplasty, in the Department of Orthopaedics, between September 2009 and October 2012. Functional outcome was assessed and compared using Harris hip score and radiological parameters with a follow-up of one year.
RESULTS: The two groups of patients with mean age of 67.3 in bipolar group and 75.6 in unipolar group did not differ in their pre-injury characteristics and perioperative parameters. The mean Harris hip score in bipolar and unipolar groups was 86.18±12.18 and 79.79±15.55, respectively (p=0.183); range of motion was 210.63±28.39 and 181.58±37(p=0.015) with bipolar and unipolar groups, respectively. Functional activities were better in the bipolar group. Complications like painful hip, posterior dislocation, periprosthetic fracture and acetabular erosion were encountered in unipolar prostheses.
CONCLUSION: The use of bipolar endoprosthesis in the management of displaced femoral neck fractures in the elderly was associated with better mean Harris hip score and incidence of complications was limited. Hence, bipolar would be a better option in elderly patients with fracture neck of femur.
KEY WORDS: Unipolar; Bipolar; Hemiarthroplasty.