Assessing the Radiological and Functional Outcomes of Colles' Cast Versus Functional Position Cast Immobilization in the Conservative Treatment of Distal End of Radius Fractures.

INTRODUCTION: The distal end radius fracture represents a prevalent orthopedic condition that affects individuals across various age groups, commonly resulting from falls onto outstretched hands. Ongoing research endeavors have delved into diverse methodologies for addressing this condition, encompassing conservative and operative modalities, yielding variable outcomes. While the literature extensively delineates numerous mobilization approaches, such as the functional position cast and Colle's cast, scant comparative studies evaluate these immobilization forms. Consequently, our study sought to holistically appraise and compare the radiological and functional outcomes associated with Colles' cast and functional position cast immobilization in managing distal end radius fractures. METHOD: This retrospective study was conducted at a tertiary trauma center over two years, from October 2018 to September 2020. Data was collected from medical records with prior approval from the institutional ethics committee. The study included 64 patients, all above the age of 40, who suffered from distal end radius fractures and received conservative management. Patients with bilateral distal end radius fractures, associated ipsilateral limb injury, open or comminuted fractures, or inadequate medical records were excluded. The patients were divided into two groups based on the type of cast immobilization: group I comprised 30 patients managed with Colles' cast immobilization (volar-flexion and ulnar deviation position). In contrast, group II consisted of 34 patients with functional position cast immobilization (immobilization with dorsiflexion). The clinical (including pain, thumb swelling, finger swelling, finger stiffness, shoulder stiffness, and tenderness), radiological (including radial deviation, radial height, and volar tilt), and functional (range of motion (ROM), and disability of arm, shoulder, and hand (DASH)) outcomes were evaluated at 6, 12, and 24 weeks. The data analysis was conducted using the IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). The chi-square test, independent samples t-test, and paired t-test were employed to analyze and compare radiological and functional outcomes between the two groups. A p-value of less than 0.05 indicated a statistically significant association. RESULTS: The radiological parameters, including volar tilt, radial inclination, and radial shortening, were derived from the medical records at various points: pre-reduction, post-reduction, 6-week follow-up, 12-week follow-up, and 24-week follow-up. Upon assessing these parameters, no statistically significant variance was observed between the two groups at specified time points. Comparison of the ROM between the two groups unveiled noteworthy results, indicating superior outcomes in the functional cast group at 6 and 12 weeks as opposed to the Colles' cast group. Grip strength assessment at the 24-week follow-up demonstrated statistically significant differences, with the functional cast group displaying enhanced grip strength. CONCLUSION:  Our study revealed comparable radiological parameters between the two cohorts, yet it demonstrated a notable enhancement in both the ROM and functional outcomes in those subjected to functional cast positioning. These findings underscore the potential advantages of functional immobilization in bolstering patient rehabilitation.

Metabolic crosstalk: Extracellular ATP and the tumor microenvironment in cancer progression and therapy.

Adenosine 5'-triphosphate (ATP) is a vital element in energy information. It plays a critical role in transmitting signals inside the body, which is necessary for controlling the life activities of all cells, including tumor cells [1]. Its significance extends from intracellular signaling pathways to tumor regression. Purinergic signaling, a form of extracellular paracrine signaling, relies on purine nucleotides. Extracellular ectonucleotidases convert these purine nucleotides to their respective di and mono-phosphate nucleoside forms, contributing significantly to immune biology, cancer biology, and inflammation studies. ATP functions as a mighty damage-linked molecular pattern when released outside the cell, accumulating in inflammatory areas. In the tumor microenvironment (TME), purinergic receptors such as ATP-gated ion channels P2X1-5 and G protein-coupled receptors (GPCR) (P2Y) interact with ATP and other nucleotides, influencing diverse immune cell activities. CD39 and CD73-mediated extracellular ATP degradation contributes to immunosuppression by diminishing ATP-dependent activation and generating adenosine (ADO), potentially hindering antitumor immunity and promoting tumor development. Unraveling the complexities of extracellular ATP (e-ATP) and ADO effects on the TME poses challenges in identifying optimal treatment targets, yet ongoing investigations aim to devise strategies combating e-ATP/ADO-induced immunosuppression, ultimately enhancing anti-tumor immunity. This review explores e-ATP metabolism, its purinergic signaling, and therapeutic strategies targeting associated receptors and enzymes.

A Prospective Study Comparing the Functional Outcome of Bipolar Hemiarthroplasty Versus Total Hip Replacement in Elderly Patients With Fracture of the Neck of Femur.

Introduction Displaced fractures of the neck of femur in elderly patients usually require surgical intervention, with either bipolar hemiarthroplasty (BHA) or total hip replacement (THR). However, there is still controversy regarding the optimal prosthesis. The present study was performed to compare the functional outcome of BHA versus THR in elderly patients with displaced fracture of the neck of femur. Materials and methods This prospective study was conducted between December 2019 and December 2021. This study included 40 patients with displaced fracture of the neck of femur. All patients were more than 60 years of age. The patients were randomly allocated to be treated with either BHA or THR. Functional assessment was done using Harris hip scores at one month, three months, six months, and one year postoperatively. Results In our study, at all follow-ups, the Harris hip score was found to be more in patients in the THR group than in the BHA group. In the BHA group, the mean Harris hip scores were 59.95, 66.25, 68.80, and 75.70 at the follow-up visits at one month, three months, six months, and one year, respectively, while in the THR group, the mean Harris hip scores were 65.06, 69.40 72.50, and 78.19, respectively. Conclusion THR is a better option as compared to BHA in the management of elderly patients with fracture of the neck of femur on account of less complication rates and higher Harris hip scores.

Antero-posterior axis of tibia in patient undergoing total knee replacement in Indian population.

INTRODUCTION: Aim of this CT- based study was to find out a reliable anatomical axis for proper rotational placement of the tibial component during knee replacement surgery in the Indian population. MATERIAL AND METHODS: CT scanning was performed pre-operatively on all the 45 patients (13 men, 32 women, total 68 knees) due to undergo knee replacement for osteo-arthritic knees. The tibial anteroposterior (AP) axis is defined as a line drawn perpendicular to the surgical epicondylar femoral axis and passing through the center of posterior cruciate ligament (PCL) attachment. Angles between various anatomic landmarks and the defined tibial AP axis were identified. RESULTS: The mean angle between line connecting the medial border of patellar tendon and centre of PCL and the defined tibial AP axis was 0.06 (-5 to 7; SD 2.65) and was closest to defined AP axis of tibia. This axis remained the closest irrespective of the varying femoro-tibial angle and severity of tibial bowing. DISCUSSION: In our patients, the line connecting the medial border of patellar tendon to the centre of the PCL has been found to be an independent, reliable and reproducible rotational axis for placing the tibial trial and definitivite prosthesis. This is particularly helpful for those surgeons, who prepare the femur earlier than the tibial cut and trial. CONCLUSION: This tibial AP axis along with other anatomical landmarks is a reliable and reproducible landmark for implanting the tibial prosthesis in a proper rotational alignment in the Indian population.

Klippel Feil Syndrome: A Rare Case Report.

INTRODUCTION: In Klippel Feil syndrome, classically there is a triad of short neck, a low posterior hairline and a limited range of neck movements especially of lateral bending. In fewer than 50% of cases have all the three elements. CASE REPORT: In the present case we have found congenital Scoliosis, Sprengel deformity and there were no evidence of renal disease, congenital heart disease and neurological impairment. The present case has classical triad low posterior hairline, short neck and limited cervical range of motion. CONCLUSION: A rare case of Klippel Feil Syndrome is being presented with the aim that such cases should be identified and treated at an early stage to minimize cosmetic & social stigma to her and to her parents.

Outcome of traumatic subtrochanteric femoral fractures fixed using cephalo-medullary nails.

We performed a retrospective review of 101 patients sustaining 102 traumatic, non-pathological subtrochanteric fractures treated with cephalo-medullary nailing over a period of 6 years from 1999 to 2005. Mean follow up was 24 weeks (range: 6-96). Twenty patients were lost to follow up and 21 died, whilst 57 of 60 fractures were followed to union. There were 19 fractures fixed in varus, as defined as a varus angulation of greater than 10 degrees at the fracture site. Implant failure, 9 of the 10 malunions and all 3 of the non-unions occurred in the varus group whilst only 1 malunion occurred in the satisfactory reduction group. This difference in outcome is statistically significant (p<0.0001). Twenty four of the 60 patients had undergone open reduction at the time of fixation. There were three malunions and one non-union in the open reduction group compared with six and two, respectively in the closed group (p>0.05). Post-operative recovery rates, infection rates and other complications were similar for both groups. We therefore advocate the use of open reduction where necessary to avoid varus malreduction to avoid such complications, particularly as open reduction was not associated with a higher complication rate in this series. The study supports the use of cephalo-medullary nailing for subtrochanteric fractures with a union rate of 95%.

A comparison of fixed-bearing and mobile-bearing total knee arthroplasty at a minimum follow-up of 4.5 years.

BACKGROUND: Durable long-term independent results with the Low Contact Stress rotating-platform (mobile-bearing) and the Insall Burstein-II (fixed-bearing) total knee prostheses have been reported, but no studies describing either the mid-term or long-term results and comparing the two prostheses are available, to our knowledge. METHODS: Thirty-two patients who had bilateral arthritis of the knee with similar deformity and preoperative range of motion on both sides and who agreed to have one knee replaced with a mobile-bearing total knee design and the other with a fixed-bearing design were prospectively evaluated. Comparative analysis of both designs was done at a mean follow-up period of six years, minimizing patient, surgeon, and observer-related bias. Clinical and radiographic outcome, survival, and complication rates were compared. RESULTS: Patients with osteoarthritis had better function scores and range of motion compared with patients with rheumatoid arthritis. However, with the numbers available, no benefit of mobile-bearing over fixed-bearing designs could be demonstrated with respect to Knee Society scores, range of flexion, subject preference, or patellofemoral complication rates. Radiographs showed no difference in prosthetic alignment. Two knees with a mobile-bearing prosthesis required a reoperation: one had an early revision because of bearing dislocation and another required conversion to an arthrodesis to treat a deep infection. CONCLUSIONS: We found no advantage of the mobile-bearing arthroplasty over the fixed-bearing arthroplasty with regard to the clinical results at mid-term follow-up. The risk of bearing subluxation and dislocation in knees with the mobile-bearing prosthesis is a cause for concern and may necessitate early revision. LEVEL OF EVIDENCE: Therapeutic Level II.