Virtual reality is effective in the management of chronic low back ache in adults: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND: Chronic low back ache (CLBA) is a common condition that is conventionally managed with physical therapy and analgesics. Recently, virtual reality-based interventions have been tried out in the management of CLBA. Their effectiveness, however has not been established. This meta-analysis aims to find out if the application of VR will lead to better pain relief, as compared to conventional techniques in adults with CLBA. METHODS: The literature search was carried out in three online databases for potential randomized controlled trials that compared VR-based interventions with conventional treatment in CLBA. Data on outcome parameters were recorded. Meta-analysis was carried out with the help of appropriate software. RESULTS: Seven studies having data on 507 subjects were included in the meta-analysis. Their mean ages were 48.4 years. There were 252 subjects in the VR group and 255 in the control group. VR-based interventions were found to have a statistically significant improvement in the pain intensity compared with conventional techniques (p - 0.005). CONCLUSION: VR-based interventions are effective in the management of CLBA in the short term. Further research with longer follow-up is required to evaluate if these improvements are persistent in the long term.

Does the residual displacement of pelvic ring affect the functional outcome in pelvic ring injures?

PURPOSE: The effects of residual displacement on the functional outcome of the patient are not distinctly known and the acceptability criteria of residual displacement of the pelvic ring remain disputed. The purpose of this study is to evaluate the effect of residual displacement on functional outcome in pelvic ring injuries. MATERIALS AND METHODS: A total of 49 patients with pelvic ring injuries (both operative and non-operative) were followed up for six months. Anteroposterior (AP), Vertical and rotational displacements were measured at admission, after surgery and at six months. Resultant displacement (vector addition of AP and vertical displacement) was taken for comparison. Displacement was graded as excellent, good, fair and poor according to Matta's criteria. Functional outcome assessment was done at six months using Majeed score. Work adjusted Majeed score was calculated for non-working patients by taking the percentage score. RESULTS: We compared the means of residual displacement with functional outcome (Excellent/Good/Fair) and found that there was no significant difference between the groups in operative (P=0.33) or non-operative patients (P=0.09). This showed that patients with relatively higher residual displacement also had satisfactory functional outcomes. The functional outcomes were compared after dividing the residual displacement into 2 groups: <10 mm and >10 mm and no significant difference was found in outcomes for either operative or non-operative patients. CONCLUSION: Up to 10 mm of residual displacement is acceptable in pelvic ring injuries. More prospective studies with a longer follow up are needed for determination of correlation between reduction and functional outcome.

Emerging Advances in Nanocarriers Approaches in the Effective Therapy of Pain Related Disorders: Recent Evidence and Futuristic Needs.

Pain disorders are the primary cause of disability nowadays. These disorders, such as rheumatoid arthritis (RA) and osteoarthritis (OA), cause loss of function, joint pain and inflammation and deteriorate the quality of life. The treatment of these inflammatory diseases includes anti-inflammatory drugs administered via intra-articular, topical or oral routes, physical rehabilitation or surgery. Owing to the various side effects these drugs could offer, the novel approaches and nanomaterials have shown potential to manage inflammatory diseases, prolonged half-life of anti-inflammatory drugs, reduced systemic toxicity, provide specific targeting, and refined their bioavailability. This review discusses in brief about the pain pathophysiology and its types. The review summarizes the conventional therapies used to treat pain disorders and the need for novel strategies to overcome the adverse effects of conventional therapies. The review describes the recent advancements in nanotherapeutics for inflammatory diseases using several lipids, polymers and other materials and their excellent efficiency in improving the treatment over conventional therapies. The results of the nanotherapeutic studies inferred that the necessity to use nanocarriers is due to their controlled release, targeting drug delivery to inflamed tissues, low toxicity and biocompatibility. Therefore, it is possible to assert that nanotechnology will emerge as a great tool for advancing the treatment of pain disorders in the near future.

Management of ipsilateral trifocal fracture of the radius-a case report.

Introduction: Diaphyseal forearm fractures are commonly seen in clinical practice. However, segmental forearm fractures are relatively rare. We hereby present a case of surgical management of trifocal fracture of radius (mid-shaft of radius, distal end of radius and neck of radius fracture) with ipsilateral shaft ulna fracture. Case report: A middle aged patient with ulnar shaft fracture and trifocal radius fracture was managed surgically with open reduction and internal fixation of all four fractures. The ulna was addressed first, to achieve alignment, followed by distal radius and shaft radius fixation through the same incision. A separate incision was used to address radial neck fracture. Conclusion: A trifocal radius fracture with ulna shaft fracture has been rarely reported in the literature. Prompt surgical management of the complex fracture led to rapid and satisfactory recovery and good functional outcome for our patient.