Outcomes of Allograft Medial Patellofemoral Ligament Reconstruction in Children and Adolescents with Hypermobility.

Introduction: Medial patellofemoral ligament (MPFL) reconstruction is used to treat patellofemoral instability either in isolation or in combination with other procedures. Use of allograft can preserve native tissue in children and can be advantageous in patients with connective tissue disorders, including ligamentous laxity. There is limited evidence regarding functional outcomes of allograft MPFL reconstruction in children and adolescents. This study aimed to assess the short to mid-term results of allograft MPFL reconstruction in children with hypermobility at a tertiary pediatric orthopedic center. Materials and Methods: We retrospectively reviewed all children and adolescents who had undergone allograft MPFL reconstruction over 4 years. The primary outcome measure was the validated Kujala score for patellofemoral disorders. The secondary outcome measures included complications such as redislocation of the patella needing revision surgery. Patients with hypermobility were quantified using Beighton criteria. Statistical analysis was performed using Graph Pad Prism (V6). Results: Between 2012 and 2016, the senior author performed 76 allograft MPFL reconstructions in 57 patients. Nineteen patients had bilateral surgery. The mean age was 14 (7-16) years with a female: male ratio of 3:1. The mean Beighton score was 7. Hypermobility was part of a syndrome in ten patients. The mean follow-up was 3 (1-4) years. Nine patients had trochleoplasty and six patients had tibial tubercle osteotomy, in addition to allograft MPFL reconstruction. These fifteen patients, who had additional procedures, were excluded during the analysis of the outcome measures. The mean Kujala score was 89 (80-100). The overall complication rate was 11% (9/76). These included two patella fractures and seven (9%) patients with recurrent instability needing revision surgery. There was no significant difference in complication rates between syndromic and nonsyndromic patients (P = 0.9). Conclusion: Our study shows excellent short to mid-term functional outcomes of allograft MPFL reconstruction in children and adolescents with hypermobility.

Effect of zoledronic acid on fracture healing in osteoporotic patients with intertrochanteric fractures.

AIMS: To assess the effect of zoledronic acid (ZOL) on fracture healing in osteoporotic patients with intertrochanteric fracture based on radiological evaluation and to study the correlations between severity of osteoporosis, age, gender, and time taken to fracture union. SETTINGS AND DESIGN: An open label study was conducted on 43 patients at a tertiary care center. SUBJECTS AND METHODS: The osteoporosis status of all the included patients was documented using a double-energy X-ray absorptiometry scan. A single dose of injection ZOL 5 mg was administered intravenously to all the patients after fixation during their hospital stay. Follow-up of the patients was done at 1, 3, and 6 months after surgery until union was seen radiologically. STATISTICAL ANALYSIS USED: Data were entered into Microsoft Office Excel version 2007, and interpretation and analysis of obtained data were done using summary statistics. Pearson correlation between age, gender, bone mineral density (BMD), and time taken to fracture union was done using the IBM SPSS Version 22.0 (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.). RESULTS: The average age of the patients included in the study was 71.27 ± 11.48 and the average BMD was -4.58±1.42. All the fractures united by the 6th month of follow-up, which was similar to the union rate in comparison with the literature. The correlations between the gender, BMD, age, and time to union were calculated, and all the r values obtained showed very low correlation and the P values in all the variables were not significant. CONCLUSION: The bisphosphonate therapy did not adversely affect radiologically determined fracture union, and no correlations between severity of osteoporosis, age, gender, and time taken to fracture union were found to be significant.

A Study on the Correlation of Pertrochanteric Osteoporotic Fracture Severity with the Severity of Osteoporosis.

INTRODUCTION: Osteoporosis is a metabolic bone disease caused by progressive bone loss. It is characterized by low Bone Mineral Density (BMD) and structural deterioration of bone tissue leading to bone fragility and increased risk of fractures. When classifying a fracture, high reliability and validity are crucial for successful treatment. Furthermore, a classification system should include severity, method of treatment, and prognosis for any given fracture. Since it is known that treatment significantly influences prognosis, a classification system claiming to include both would be desirable. Since there is no such classification system, which includes both the fracture type and the osteoporosis severity, we tried to find a correlation between fracture severity and osteoporosis severity. AIM: The aim of the study was to evaluate whether the AO/ASIF fracture classification system, which indicates the severity of fractures, has any relationship with the bone mineral status in patients with primary osteoporosis. We hypothesized that fracture severity and severity of osteoporosis should show some correlation. MATERIALS AND METHODS: An observational analytical study was conducted over a period of one year during which 49 patients were included in the study at HIMS, SRH University, Dehradun. The osteoporosis status of all the included patients with a pertrochanteric fracture was documented using a DEXA scan and T-Score (BMD) was calculated. All patients had a trivial trauma. All the fractures were classified as per AO/ASIF classification. Pearson Correlation between BMD and fracture type was calculated. STATISTICAL ANALYSIS USED: Data was entered on Microsoft Office Excel version 2007 and Interpretation and analysis of obtained data was done using summary statistics. Pearson Correlation between BMD and fracture type was calculated using the SPSS software version 22.0. RESULTS: The average age of the patients included in the study was 71.2 years and the average bone mineral density was -4.9. The correlation between BMD and fracture type was calculated and the r-values obtained was 0.180, which showed low a correlation and p-value was 0.215, which was insignificant. CONCLUSION: Statistically the pertrochanteric fracture configuration as per AO Classification does not correlate with the osteoporosis severity of the patient.

The Role of a Single Dose of Sublingual Nifedipine in Managing Hypertensive Emergencies in the Patients who Undergo Haemodialysis.

INTRODUCTION: The hypertensive emergencies in haemodialysis require immediate therapy, usually by parenteral drug administration; however, sublingual medications may have a potential in this special condition. METHODS: A prospective, non randomized, case control study was carried out to know the effectiveness and the safety of a single dose of 5mg Nifedipine (sublingual) in this subset of patients. About 100 patients were studied, who were on maintained haemodialysis and were having high Blood Pressure (BP) during the haemodialysis. The patients were monitored for about 5 hours. RESULTS: The patients who had chronic renal failure, who were maintained on regular haemodialysis, who had high systolic and diastolic blood pressure of >220 (systolic) and >125 (diastolic) respectively, were subjected to the study. These patients were of the 20-70 years age group, who visited our hospital between January 2010 to January 2011. Out of the 100 patients 30% were females and the rest (70%) were males. A single dose of nifedipine (5 mg by the sublingual route) was prescribed to determine its effectiveness and safety in the treatment of hypertensive emergencies during haemodialysis. The side effects of the drug were closely monitored. The blood pressure and the heart rate were measured continuously up to 280 min post-dose. The response rates were 90 % for nifedipine. The significant hypotensive effects of sublingual nifedipine occurred at 10 min, and a maximum reduction occurred after 30 mins and it continued up to 120 min. CONCLUSIONS: We concluded that sublingual nifedipine was effective and that it seemed to have less side effects. It may be an excellent drug in the urgent treatment of hypertensive emergencies in haemodialysis.