Cemented Calcar Replacement versus Long Stem Cemented Hemiarthroplasty in Unstable Intertrochanteric Fractures in Octogenarians.

Objective The aim of the present study was to compare functional results after Cemented Calcar replacement vis-a-vis Long stem Cemented hemiarthroplasty in patients aged more than 80 years with unstable intertrochanteric fractures. Methods The present prospective, randomized trial included 140 patients with AO/OTA type 31-A2, A3 intertrochanteric femur fracture, randomized into 2 treatment groups and followed-up for a minimum of 2 years. Sixty-seven patients in group A were treated with a cemented calcar replacing prosthesis, and 65 patients in group B were treated with a cemented long stem femoral stem prosthesis. The primary end points were hip functions at 2 years. The secondary end points were the complications encountered, mortality, surgical time, reoperation, blood loss, and activities of daily living. Results There were no major differences between the groups in terms of hip function, quality of life (health related), reoperation, mortality, and blood loss. However, the function in hip joint and activities of daily living deteriorated in both groups in comparison with prefracture levels. Conclusion In octogenarians with an unstable intertrochanteric fracture, cemented calcar replacing prosthesis has similar clinical results in comparison with long stem cemented hemiarthroplasty. Hemiarthroplasty with either implant is a good option in this subset of patients. Level of evidence: I.

Cemented Calcar Replacement versus Long Stem Cemented Hemiarthroplasty in Unstable Intertrochanteric Fractures in Octogenarians / Substituição do calcar cimentado versus hemiartroplastia de haste longa cimentada em fraturas intertrocantéricas instáveis em octogenários

Abstract Objective The aim of the present study was to compare functional results after Cemented Calcar replacement vis-a-vis Long stem Cemented hemiarthroplasty in patients aged more than 80 years with unstable intertrochanteric fractures. Methods The present prospective, randomized trial included 140 patients with AO/OTA type 31-A2, A3 intertrochanteric femur fracture, randomized into 2 treatment groups and followed-up for a minimum of 2 years. Sixty-seven patients in group A were treated with a cemented calcar replacing prosthesis, and 65 patients in group B were treated with a cemented long stem femoral stem prosthesis. The primary end points were hip functions at 2 years. The secondary end points were the complications encountered, mortality, surgical time, reoperation, blood loss, and activities of daily living. Results There were no major differences between the groups in terms of hip function, quality of life (health related), reoperation, mortality, and blood loss. However, the function in hip joint and activities of daily living deteriorated in both groups in comparison with prefracture levels. Conclusion In octogenarians with an unstable intertrochanteric fracture, cemented calcar replacing prosthesis has similar clinical results in comparison with long stem cemented hemiarthroplasty. Hemiarthroplasty with either implant is a good option in this subset of patients. Level of evidence: I

Resumo Objetivo O objetivo do presente estudo foi comparar os resultados funcionais após a substituição do Calcar cimentado em comparação com a hemiartroplastia cimentada de haste longa em pacientes com mais de 80 anos com fratura intertrocantérica instável. Métodos O presente estudo prospectivo e randomizado incluiu 140 pacientes com fratura de fêmur intertrocantérica, conforme classificação AO/OTA tipo 31-A2, A3, randomizados em 2 grupos de tratamento e acompanhados por um período mínimo de 2 anos. Sessenta e sete pacientes do grupo A foram tratados com uma prótese de substituição do calcar cimentada e 65 pacientes do grupo B foram tratados com uma prótese femoral de haste longa cimentada. Os desfechos primários foram as funções do quadril em 2 anos. Os eventos secundários foram as complicações encontradas, a mortalidade, o tempo cirúrgico, segunda cirurgia, perda de sangue e as atividades do cotidiano. Resultados Não houve grandes diferenças entre os grupos em termos de função do quadril, qualidade de vida (relacionada à saúde), segunda cirurgia, mortalidade e perda de sangue. No entanto, a função da articulação do quadril e as atividades da vida diária se deterioraram em ambos os grupos em comparação com os níveis pré-fratura. Conclusão Nos octogenários com fratura intertrocantérica instável, a prótese de substituição do calcar cimentada apresentou resultados clínicos semelhantes em comparação com a hemiartroplastia de haste longa cimentada. A hemiartroplastia comqualquer umdos implantes é uma boa opção nesse subgrupo de pacientes. Nível de evidência: I

Seropositivity Load in Orthopedic Surgery at Tertiary Care Hospitals in North India - An Observational Study.

BACKGROUND: Exposure to blood and blood-borne viruses is major concern for orthopedic surgeons and operation theater staff because of constant exposure to sharp instruments and bodily fluids. The objective of this study was to assess the burden of seropositive patients in the orthopedic department of tertiary care hospitals in North India. MATERIALS AND METHODS: This retrospective study was carried out in author's institute on indoor patients admitted from January 2015 to December 2017. A total of 8914 patients were included in the study and relevant clinical data were collected for seropositivity of hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) in patients admitted in the orthopedic emergency department. These patients were routinely tested for seropositivity before undergoing various surgical procedures. RESULTS: A total of 8914 patients included in the study, out of which 7193 (80.7%) were male and 1721 (19.3%) were female. Out of total patients, 262 (2.9%) were found to be seropositive. Out of these patients, 31 (11.8%) were found to be positive for HIV, 190 (72.5%) for HCV, and 41(15.7%) for HBV. About 35.90% of patients with highest prevalence of seropositivity were truck drivers. CONCLUSION: HIV, HBsAg, and HCV are common in this region with HCV infection being the major concern in Punjab. Screening for viral markers will help in adequate pre-operative planning, timely precautions, and immediate post-exposure prophylaxis in case of contact with blood or body fluids of seropositive patients.

Spinal Tuberculosis - Directly Observed Treatment and Short Course or Daily Anti Tubercular Therapy -Are We Over Treating?

STUDY DESIGN: Prospective randomised control trial. PURPOSE: To compare the effectiveness of Directly Observed Treatment and Short Course (DOTS) and Daily Anti Tubercular Therapy (ATT) in spinal tuberculosis with no neurological deficit. OVERVIEW OF LITERATURE: Spinal tuberculosis is rampant in India with a major cause of morbidity and mortality. There is a lot of conflict regarding management with anti tubercular drugs, the regimen to be followed and the duration the drugs needed for complete cure. MATERIAL AND METHODS: This prospective study was conducted during the period of 2006 to 2009. Thirty cases of spinal tuberculosis were randomly divided equally into two groups of fifteen each and treated with DOTS and Daily ATT and compared at the end of follow up on clinical, radiological and Erythrocyte Sedimentation Rate values (ESR). RESULTS: Pain score on Visual Analogue Scale (VAS) exhibits that mean pain score was 5.93+_1.54 at start and 0.64+_1.01 at the end of follow up with 89.39% change with DOTS therapy whereas mean pain score was 7.08 +_1.61at start of therapy and 0.69+_0.95 at end of follow up with 91.73% change in patients treated with Daily ATT with p value >0.05 (not significant). The radiological recovery in patients with DOTS and Daily ATT have similar results after 1.5 years with p value > 0.05 showing that the radiological recovery by both treatment modalities are comparable. Mean change in ESR scores in DOTS therapy patients and patients on daily ATT were 74.57+_9.34% and 75.69+_9.38% change with p value >0.05 which was not significant. CONCLUSION: DOTS therapy is an effective means of management of spinal tuberculosis cases with no neurological involvement, however its efficacy in patients with neurological deficit is further to be evaluated.