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Introduction Lumbar disc prolapse mainly occurs in the regions involving the L4-L5 and L5-S1 vertebrae. In this context, the significance of spinopelvic parameters becomes notably prominent. Non-invasive management of lumbar disc prolapse encompasses medicinal therapy, physical therapy, exercise, and epidural injections. Because of its autologous blood origin, platelet-rich plasma (PRP) therapy has minimal risks associated with immunogenic reactions and side consequences. We evaluated the extent of pain reduction and improvement of functional outcomes in patients having discogenic low back pain with modified spinopelvic parameters before and after undergoing transforaminal autologous PRP injection interventions. Methodology An observational study was conducted between September 2022 and August 2023 on 100 patients with low back pain for six months. The study population comprised patients who did not respond to conservative treatment; they were recruited from the orthopaedic ward of the emergency medicine department and outpatient department at the RL Jalappa Hospital and Research Centre affiliated with Sri Devaraj Urs Medical College in Kolar, India. Every patient received a thorough evaluation that comprised an extensive medical history, a clinical examination, and imaging of the lumbosacral spine from both the front and side views. After obtaining the patient's consent and confirming their readiness for surgery, a PRP injection was administered. The injection technique followed the standardized protocol and was performed by an experienced spine surgeon in collaboration with orthopaedic residents. Pain evaluations utilizing the Visual Analog Scale (VAS) and assessment of functional outcomes using the Oswestry Disability Index (ODI) scale were conducted before and after PRP injections at the one- and six-month follow-ups. Results The average age of the study participants was 41.82 ± 5.0 years, with 55% of them being male. A total of 39% of study samples exhibited an increased angle in spinopelvic parameters. The independent t-test revealed a statistically significant difference in the mean score of back pain, limb pain, and ODI score between patients with increased and decreased angles of spinopelvic parameters before and after injection (p=0.0001). The severity of back pain, leg pain, and functional disability was significantly reduced in patients with increased angles of spinopelvic parameters following PRP injections at the one-month follow-up (p=0.0001). However, at the six-month follow-up, patients encountered recurring symptoms and worsening back pain, leg pain, and functional disability compared to the one-month follow-up. Conversely, the severity of back pain, leg pain, and functional disability has been markedly reduced in the patients with lower spinopelvic parameter angles following PRP injections at one month (p=0.0001) and six months (p=0.0001) compared to pre-injections. Conclusion During the long-term follow-up, subjects with elevated spinopelvic parameter angles reported a lower level of improvement in functional outcome, leg pain, and back pain. The impact of spinopelvic parameters on back pain severity and functional disability is substantial, significantly affecting the functional outcome of patients with lumbar disc prolapse.
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Introduction Mechanical low back pain frequently originates from the lumbar facet joint (LFJ). Axial low back discomfort can result from osteoarthritis in the LFJ. Depending on the severity of LFJ degeneration, the effect of intra-articular (IA) LFJ corticosteroid injection may vary. For LFJ discomfort, IA block with steroids and local anaesthetics has also been utilised, with varying degrees of success. The main objective of this study was to assess the efficacy of IA steroid injections dexamethasone vs. triamcinolone acetonide for the treatment of LFJ syndrome and to compare functional outcome in terms of Visual Analog Scale (VAS) score, Modified Oswestry Disability Index (MODI) score, and short-form McGill Pain Questionnaire between the two groups. Methodology Dexamethasone 8 mg or triamcinolone acetonide 40 mg was given intra-articularly to 27 patients comprising group A and 33 patients comprising group B, respectively (total 60 patients). Before intervention and at one, three, and six months, observation was conducted using the VAS score, short-form McGill pain questionnaire, and MODI score. Results There was a significant difference between both the groups after the procedure with pain alleviation and functional improvement, more in the group that received triamcinolone acetonide. A significant difference was observed in all three parameters that assessed pain with differences more pronounced at six months. Conclusion Pain reduction and clinical outcomes were better among the group that received triamcinolone acetonide. Injection of a steroid alone is associated with its own side effects. When a lumbar transforaminal epidural injection is used to treat radiculopathy in the lumbar area, particulate medication (triamcinolone) is more effective than non-particulate medication (dexamethasone) with no known drug-related complications.
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Background Open fractures are common and serious injuries that primarily affect young males. Fracture management has improved in the last decade. However, infections with their complications are still a concern, especially in open fractures for primary closure of the injured area. A newer technique called vacuum-assisted therapy has become a therapy of choice for many orthopedic surgeons. This study aimed to determine whether vacuum-assisted closure reduces the duration of wound healing and the frequency of infections after fixation of Gustilo-Anderson Type IIIA/IIIB fractures of the extremities. Methodology An observational analytical study was conducted among 34 patients with Gustilo-Anderson Type IIIA/IIIB fractures of the limbs who presented to the Department of Orthopaedics, R. L. Jalappa Hospital, Kolar, from December 2019 to July 2021. Negative-pressure wound therapy was employed for wound closure after fixation of fractures. Patients were followed up for one month. Results The mean age of the patients was 37.06 ± 10.340 years. The prevalence of infection before vacuum-assisted closure dressing was 80.6%, and the prevalence of infection after vacuum-assisted closure dressing was 19.4%. The difference in proportion before versus after the intervention was statistically significant (p < 0.001) according to the McNemar Test. Hence, vacuum-assisted closure dressing decreased the rate of infection. The mean dimension of the wound before vacuum-assisted closure therapy was 66.05 cm2 and the mean dimension of the wound after vacuum-assisted closure therapy was 27.97 cm2. The difference in the mean before and after the intervention was statistically significant according to the paired t-test (p < 0.001). Hence, vacuum-assisted closure dressing helped decrease the wound size which was proven statistically. Conclusions Vacuum-assisted closure is a viable and beneficial treatment option for complicated fractures with large soft-tissue abnormalities.
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Background The occurrence of incidental durotomies (IDs) following spinal operations is a widely recognized issue. Complications such as poor outcomes, extended hospitalization, prolonged immobilization, infections, and revision surgeries are all potential consequences of inadequate durotomy management during the initial surgery. This study aims to describe the outcomes of ID repair in thoracolumbar spine surgery in terms of the Oswestry Disability Index (ODI) score and visual analog scale (VAS) when performed with the active involvement of orthopedic residents in the surgical procedure. Methodology Between April 2021 and April 2023, a hospital-based observational study was conducted among 110 patients hospitalized in the orthopedic ward at R.L. Jalappa Hospital and Research Center in Kolar, Karnataka, who required IDs due to an accidental dural tear or a postoperative CSF fluid leak following thoracolumbar spine procedures. Patients with a previous history of thoracolumbar spine surgery, vertebral tumors, spinal metastasis, infections, e.g., spondylodiscitis, or Pott's spine were excluded. The ODI score and VAS score were calculated on the postoperative day, one month, and three months following surgery. Results The mean age of the study participants was 62.81 + 10.49 years, with a male preponderance of 67.2% among the study participants. The mean BMI of study participants was 23.77 kg/m2. Approximately 24.5% of participants had a prior history of spinal surgery. Among 110 patients, 32 had postoperative complications. Six patients reported experiencing urinary retention, followed by five with CSF leakage and one with a postural headache (five cases). Based on the ODI score, mild disability was seen in 32.7% of the study samples at three months of follow-up. Based on the VAS score, moderate pain was seen among all the study samples at three months of follow-up. The ANOVA test revealed statistically significant differences in ODI and VAS score reductions between the immediate postoperative period and the one-month and three-month follow-up periods (p = 0.001 and p = 0.0247, respectively). Conclusion Less than one-third of the samples had postoperative complications. At three months, ODI scores showed mild disability in one-third of the study samples. At three months, all study samples had moderate VAS pain. The improvement in ODI and VAS scores from the day after surgery through the one-month and three-month follow-up periods was statistically significant.
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BACKGROUND: The knee is the most commonly injured joint because of its anatomical structure, its exposure to external forces, and its functional demands. Orthopaedic surgeons previously relied on clinical evaluation for diagnosing any internal derangement of the knee joint. With the advent of new clinical methods for diagnosing ligament injuries and cartilage defects, there are very less studies comparing the accuracy of all three methods, clinical examination, magnetic resonance imaging (MRI) and arthroscopy to reach a definitive diagnosis. OBJECTIVE: This study aims to compare the sensitivity, specificity, accuracy and predictive values of clinical examination and MRI with that of arthroscopy which is the ideal investigation of choice for cartilage defects and internal derangements of the knee. MATERIAL AND METHODS: A prospective, observational and hospital-based study was done on patients with internal derangement of knee and cartilage defects. Clinical examination (based on the clinical tests for each ligament), MRI (1.5 T) and arthroscopy were done on all patients, the findings of which were compared using the Chi-square test. The following parameters were assessed while using arthroscopy as the gold standard of reference: accuracy, specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV). RESULTS: Anterior cruciate ligament (ACL) was the most common ligament to be injured followed by the medial meniscus. The overall accuracy of clinical evaluation and MRI to diagnose meniscal injuries was found to be 94% and 91% respectively. The clinical examination had sensitivity and specificity of 96% and 82% in diagnosing ACL tears, respectively, whereas MRI had sensitivity and specificity of 88% and 76% respectively. For the medial meniscus, the clinical examination had sensitivity and specificity of 93% and 96% respectively whereas MRI had a sensitivity of 100% and specificity of 89%. We observed that the accuracy of MRI for grading ACL and meniscal tears was similar i.e. 79% and 78% respectively, but was slightly low (70%) for grading of chondromalacia patellae. CONCLUSION: This study supports the use of MRI and clinical assessment in the diagnosis of chondral defects and internal knee derangement. Clinical tests are reliable and have high sensitivity in diagnosing ACL tears and chondral defects when compared to MRI. Not all lesions should routinely undergo MRI for diagnostic purposes; only a few circumstances warrant its usage. MRI is less reliable in grading ACL tears, meniscal tears and chondral injuries.
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BACKGROUND: Orthopedic surgeons face a difficult task in treating serious open fractures, which usually result in complications, morbidity, and even amputation. Compound fracture wounds were traditionally treated with a standard saline dressing. To avoid infection and problems during therapy, several studies found that open fractures require early skeletal stability as well as soft tissue repair. In favoring the above fact vacuum-assisted closure (VAC) is now undergoing a paradigm shift. With this background, this study aimed to compare the effects of VAC dressing versus standard wound dressing on compound fracture wounds. METHODOLOGY: This study has been conducted as a single-blind randomized control trial among 128 patients who got admitted to the Department of Orthopedics, R L Jalappa Hospital attached to Sri Devaraj Urs Medical College, Karnataka, India from August 2019 to November 2021. The study participants were randomly allotted into two groups negative pressure wound therapy (NPWT) and standard wound therapy (SWT) consisting of 64 participants in each group. VAC dressing was used on group NPWT, while normal saline wound dressing was used on group SWT. Both groups were followed up for a month after their discharge from the hospital. Frequency in dressing changes wound healing time, infection presence, and hospitalization days were all recorded and compared over one month. The data collection was done using questionnaires and the statistical analysis was done with SPSS version 21 (Chicago, IL: IBM Corp.). RESULTS: There was a statically significant difference favoring group NPWT compared to group SWT with a hospital stay, number of dressings required, wound size reduction, wound healing time, and deep infection rate (p<0.05). CONCLUSIONS: The use of NPWT speeds up the healing of compound fracture wounds significantly. It is affordable and can be used as a substitute in resource-constrained areas to reduce infection and manage open fracture wounds quickly.
