Limited versus Aggressive Open Discectomy for a Single Level Lumbar Intervertebral Disc Prolapse.

Open lumbar discectomy is the gold standard surgical procedure for intervertebral disc herniation but still controversy exit whether limited or aggressive open discectomy provides better outcomes. Retrospectively we evaluate 2380 patients to compare the clinical outcomes, complications and recurrence rate between limited (LD) and aggressive open discectomy (AD). Records of 745 men and 255 women aged 19 to 55 (mean, 38.03±9.1) years for LD and 995 men and 385 women aged 21 to 60 (mean, 43.7±9.3) years for AD were reviewed. Demographic data, surgical data, complications and re-herniation rate were collected and assessment done by Visual analogue score (VAS), Oswestry Disability Index (ODI) and modified Mcnab criteria. The mean follow-up period was 24.5 and 28.8 months respectively. In compare to aggressive discectomy, limited discectomy required significantly less operative time (95 vs. 55 minutes, p<0.001, unpaired 't' test), less used of post-operative analgesic (p<0.05) and better patients' satisfaction (p<0.05). But low back pain, leg pain, recurrence rate, infection, per-operative blood loss and periods of hospitalization were without significant difference. Both groups achieved satisfactory clinical outcomes 85%, 78.62 % respectively. Complications were foot drop (n=2, 5), dural tear (n=7, 14), superficial wound infection (n=7, 17) and discitis (n=19, 37) and reherniation (55, 64) respectively. Limited discectomy is an alternative to the aggressive discectomy. Both groups showed satisfactory outcome but in limited discectomy group shown better satisfaction in relation to aggressive discectomy.

Close Intramedullary Interlocking Nailing Versus Locking Compression Plating In the Treatment of Closed Fracture Shaft of the Tibia.

Fracture of tibial shaft is the commonest site of long bone fractures due to its superficial location involving young or middle-age people. Proper management is an important issue regarding the future effective movements. In this study patients were grouped in closed Intra medullary interlocking nailing and locking compression plating. Post-operative follow up at 2 weeks, 6 weeks, 12 weeks and 3 months thereafter up to 6 months were done. Each of the patients was evaluated clinically and radiologically by tucker criteria of Tuker et al. Patients were assessed for pain on full weight bearing and kneeling, shortening and range of motion of knee and ankle joints. Radiological assessment for union of fracture, alignment of fracture and angulations and position of nail and screws and infection were observed during follow up. A total number of 32 patients were selected but only 27 patients were available for follow up for a period of 6 months. They were grouped into Group A, consisting of 15 patients who took the treatment in the form of closed intramedullary interlocking nailing and Group B, consisting of 12 patients those underwent ORIF with locking compression plating. In both of the groups Motor Vehicle Accident was the main mechanism of trauma. Fracture involving the middle 3rd of the tibia is common in both the groups. During post-operative follow up, four patients in Group A complained anterior knee pain, one patient in Group B had superficial infection, most of the patients had no restriction of movement in the ankle and knee joints and a single patient in Group B showed 1.5cm shortening of the lower limb. Period of hospital stay and fracture union time were less in Group A, which was statistically significant. Both groups showed excellent result with minimum complications. So this study permits to conclude that close IM interlocking nailing and open reduction and internal fixation by locking compression plating is equally effective for the management of close fracture shaft of the tibia.

Correlation between Clinical and Arthroscopic Findings in Meniscal Tear of Knee.

The meniscus is the most commonly injured structure in the knee joint. Carefully performed clinical examination can give better diagnosis of meniscal tear. The aim of this study was to find out the correlation between clinical and arthroscopic findings in meniscal tear of knee. This cross sectional observational study was conducted in the Department of Orthopaedic Surgery, BSMMU, Dhaka from July 2012 to June 2014. Thirty patients of meniscal tear were selected as per inclusion and exclusion criteria. After proper evaluation and clinical examination of these patient arthroscopic examinations was done under spinal anesthesia. A total number of 30 patients were recruited in this study. Twenty seven (90%) patients were male and only 3(10%) were female. Mean±SD of age was 26.00±5.55 and range was 17-34 years. Out of 30 patients 19(63.3%) had right knee affected and the rest 11(36.7%) had left knee affected. It was found from clinical diagnosis that most of the patients had MM injury (73.4%) and LM injury was in 26.6% patients. From arthroscopic diagnosis we found most of the patients had multiple types of injury (40.0%) followed by 26.7% patents had isolated MM injury, 16.6% patients had isolated LM injury, 10.0% patients had other injuries like ACL, PCL or MCL and rest 6.7% patients had no injury at all. Sensitivity, specificity, PPV, NPV and accuracy of clinical diagnosis in diagnosis of MM injury were 94.4%, 58.3%, 77.3%, 87.5% and 80.0% respectively. Sensitivity, specificity, PPV, NPV and accuracy of clinical diagnosis in diagnosis of LM injury were 85.7%, 91.3%, 75.0%, 95.5% and 90.0% respectively. Clinical evaluation may diagnose meniscal tear accurately.

Surgical Decompression of Resistant Cases of DeQuervain's Disease.

DeQuervain's disease of the first dorsal compartment of the wrist, is a common wrist pathology, pain results from resisted gliding of the abductor pollicis longus and the extensor pollicis brevis tendon in the fibroosseous canal. Management of resistant cases of DeQuervain's disease with failed conservative treatment treated by surgical decompression yield satisfactory outcomes. A large number of patients being dissatisfied with the medical treatment, still present with persistent pain and positive clinical finding. Surgical decompression is an effective method for the treatment of resistant cases of DeQuervain's disease. Outcome variables were measured by Scheller, Forget and Macey evaluation criteria. Most of our patients were female 28(93.3%), housewife 17(56.7%) with mean age of 41.57 years, ranging from 25-60 years. Right sided involvement was 20(66.7%) and Left sided involvement was 10(33.3%). Restricted movement of thumb in 30(100%) were the predominant symptoms. One (3.3%) patient develop chronic tenosynovitis, 1(3.3%) patient develop hypertrophic scar. There was no wound infection in the follow-up period of 3-18 months. Satisfactory results were found in 29(96.7%).