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INTRODUCTION: Severe open fractures continue to be a nightmare for orthopedicians even with use of more accepted line of treatment. Open fractures and infected non-union of femur bone are not infrequently seen in orthopedic wards as femur is the most common long bone injured. We present a case series of 14 such patients treated successfully with limb reconstruction system enabling recovery to pre-injury status and activities. CASE SERIES: The present study was done to access the role of limb reconstruction system in the management of open femur fractures and in infected non-union with modifications to meet the requirements of each case. We viewed the results of treatment of 14 cases of late presentation with complicated open femur fractures and infected non-unions. Average time of fixator removal was 4 months-24 months. Average follow-up duration was 18 months (range 6-36 months). Evaluation of results was based on ASAMI criteria. The excellent bone results were obtained in 85.72% of cases while 7.14% showed good and 7.14% were poor results. Excellent functional results were observed in 71.43% of cases and 28.57% of cases shows good and fair results. CONCLUSION: The use of limb reconstruction system is based on compression and distraction technique. It was found to be a simple and effective modality for open injuries in terms of enhanced union rate, rapid rehabilitation, and easy care of soft-tissue injury along with bone loss, thus avoiding multiple surgeries.
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Untreated traumatic posterior dislocation of the elbow joint, 3 weeks or older, is defined as "neglected posterior dislocation of the elbow". Around 90% of these are of posterolateral type. These are much more common in the developing and underdeveloped countries. Patients presents with a deformed, stiff and painful elbow with difficulty to perform activities of daily living. The clinical picture looks quite similar to malunited supracondylar fracture of the elbow. Diagnosis is usually confirmed radiographically. CT and MRI scan give additional information and are recommended before embarking on surgery. Treatment is quite challenging due to the significant soft tissue contractures, ligamentous insufficiencies and fibrosis, with possible associated nerve injuries, myositis ossificans, non-compliant patients and the need for long-term postoperative physiotherapy. Goal of surgical treatment is to achieve a painless, stable and mobile elbow with a congruent joint space. We have reviewed the literature and present our view on the prognosis and recommended surgical technique to treat this condition.
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BACKGROUND AND AIMS: Postoperative pain relief following total knee arthroplasty (TKA) is a major concern as it will help to achieve an effective functional outcome. The present study was conducted to compare continuous femoral nerve block (CFNB) and continuous epidural infusion (CEI) techniques using ropivacaine. MATERIAL AND METHODS: Forty patients were randomly allocated into group F and group E to receive 0.2% ropivacaine through femoral catheter or epidural catheter respectively. An infusion was started @6 ml/h post-operatively when VAS was ≥4. The dose was titrated to keep VAS <4 (with minimum rate 2 ml/h and maximum rate 10 ml/h). If VAS ≥4 occurred despite maximum rate of infusion, a rescue analgesic was given. Primary objectives were to compare visual analogue score (VAS), rehabilitation indices, and rescue analgesic requirement. Secondary objectives were to assess patient and surgeon's satisfaction score, motor blockade, and complications if any. RESULTS: The mean VAS score, rehabilitation goals, rescue analgesic requirement, and patient's and surgeon's mean satisfaction scores were comparable in both the groups. Motor blockade was not seen and though the number of side effects were more in group E, they did not achieve statistical or clinical significance. CONCLUSION: CFNB can be used as an alternative, effective postoperative analgesic technique for TKA.
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We have used computational fluid dynamics modeling (CFD) to synchronize the flow conditions in the flow channels of two complementary surface-sensitive characterization techniques: surface plasmon resonance (SPR) and quartz crystal microbalance (QCM). Since the footprint of the flow channels of the two devices is specified by their function, the flow behavior can only be varied either by altering the height of the flow channel, or altering the volumetric rate of flow (flow rate) through the channel. The relevant quantity that must be calibrated is the shear strain on the measurement surface (center and bottom) of the flow channel. Our CFD modeling shows that the flow behavior is in the Stokes flow regime. We were thus able to generate a scaling expression with parameters for flow rate and flow channel height for each of the two devices: f(QCM)=2.64f(SPR)(h(QCM)/h(SPR)(2), where f(QCM) and f(SPR) are the flow rates in the SPR and QCM flow channels, respectively, and h(QCM)/h(SPR) is the ratio of the heights of the two channels. We demonstrate the success of our calibration procedure through the combined use of commercially available SPR and QCM flow channel devices on both a biomolecular interaction system of surface immobilized biotin and streptavidin and a targeted drug delivery model system of biotinylated liposomes interacting with a streptavidin functionalized surface.