Prevalence of lumbosacral transitional vertebra in patients with chronic low back pain: a descriptive cross-sectional study.

BACKGROUND: Numerous causes of low back pain have been identified like spondylosis, spondylolysis, spondylolisthesis, facet lesions, discal abnormalities, vertebral instability, degenerative osteoarthritis, etc., These causes of low back pain are seen commonly in >50 years of age. Lumbosacral transitional vertebra (LSTV) is a common congenital anomaly with multitude of intermediate morphologic manifestations between the typical sacral and lumbar vertebra reported by some authors as a cause of low back pain. There are racial differences reported in the literature on the prevalence of LSTV. There is no common consensus in literature about the association between LSTV and low back pain. There is a paucity of literature on the subject in the Indian population, hence the current study was conducted. MATERIAL AND METHODS: 60 cases of low back pain and 60 controls were included in the study. Patients between 18-50 years of age with low back pain of >12 weeks duration who were fulfilling the inclusion criteria were included in the study. The plain radiographs were screened by two observers (one Orthopaedician and one Radiologist) for the presence or absence of lumbosacral transitional vertebra (LSTV) and classification was determined by consensus. The incidence of LSTV was calculated in both the groups (cases and controls) and evaluated for statistical significance. RESULTS: Prevalence of lumbosacral transitional vertebra (LSTV) was found to be 38.33% in cases group as compared to control group (21.66%) and was statistically significant (p value <0.05). Prevalence of lumbarisation was higher in case group (10%) in comparison to control group (5.0%) but not found to be statistically significant. Prevalence of sacralisation was also found to be higher in case group (28.33%) as compared to control group (16.67%). This was not found to be statistically significant. CONCLUSION: The present study showed a higher prevalence of lumbosacral transitional vertebra (LSTV) in case group (38.33%) as compared to control group (21.66%) which was found to be statistically significant. Prevalence of lumbarisation and sacralisation were both found to be higher in the case group in comparison to control group, but the difference was not statistically significant. However, further studies with larger sample would be needed to conclusively determine any association between low back pain and subtypes of LSTV.

Wound Assessment Using Bates Jensen Wound Assessment Tool in Acute Musculoskeletal Injury Following Low-Cost Wall-Mounted Negative-Pressure Wound Therapy Application.

Background: Negative-pressure wound therapy (NPWT) is an alternative method of wound management for spontaneous healing. However, availability and high cost of a conventional NPWT system remain a challenge. Bates Jensen wound assessment tool (BWAT) has been used to assess wound healing in diverse wound treatments. Although there have been studies evaluating change in BWAT score following application of commercially available NPWT device, there is no literature evaluating change in BWAT score following use of wall-mounted low-cost NPWT device. Materials and Methods: Twenty patients above the age of 18 years with acute musculoskeletal wounds who underwent surgical debridement and required subsequent wound coverage were included in the study. Wound dressings were carried out using low-cost wall-mounted negative-pressure device utilizing a constant pressure of 125 mmHg for 48 h. Wound scoring was done using the Bates Jensen wound assessment tool (BWAT). The wound scores before and after application of NPWT were compared and analyzed using Wilcoxon signed-rank test. Results: Twenty patients fulfilling the inclusion criteria with a mean age of 37.10 ± 14.37 were included in the study. The average BWAT score before and after NPWT application was 31.2 ± 4.63 and 27.8 ± 3.68, respectively. The mean reduction in total BWAT score following NPWT application was 3.4. The granulation profile improved in 90% (n = 18/20) cases with a mean reduction of 1.5 ± 0.4 in the granulation tissue score. Exudation decreased in 60% (n = 12/20) patients with a mean reduction of 0.5 ± 0.23 in exudation type score and 0.35 ± 0.13 in exudation amount score. The necrotic tissue domain improved in 45% (n = 9/20) of the cases with a mean reduction of 0.45 ± 0.31 in necrotic tissue type score and 0.20 ± 0.12 in necrotic tissue amount score. Conclusion: There was a statistically significant reduction in the total BWAT score (p = 0.001) and an increase in granulation tissue (p = 0.001). The decrease in wound exudation (p = 0.004) and necrotic tissue coverage of the wound (p = 0.007) was also significant. However, there was no statistically significant change in wound depth, size, edges, undermining, tissue edema, tissue induration, and wound epithelialization after 48 h of continuous low-cost wall-mounted negative suction application in these patients.

Assessment of inter and intra-observer variation of Leonetti and Tigani CT bases classification of tibial pilon fractures.

INTRODUCTION: tibial pilon fracture constitutes 5-7% of all tibial fractures. The treatment of choice is an open reduction with anatomical articular reconstruction and stable fixation. A relievable fracture classification is needed for the preoperative planning the surgical management of these fractures. Hence, we assessed the inter- and intra-observer variation of Leonetti and Tigani CT bases classification of tibial pilon fractures. MATERIALS AND METHODS: In this prospective study, 37 patients aged between 18-65 years with an ankle fracture were included. All these patients underwent a CT scan for the ankle fracture, and the CT scan was further evaluated by 5 independent observers (Orthopaedic surgeon). A kappa value was determined for inter and intra-observer variation. RESULTS: Leonetti and Tigani's CT-based classification of the kappa values was 0.657 to 0.751, with a mean value of 0.700. The range of values for the intra-observer variation using Leonetti and Tigani CT-based classification on the kappa values was 0.658 to 0.875 with a mean value of 0.755. The P-value < 0.001 states that there was a significant agreement between the inter-observer and intra-observer classification. CONCLUSION: Leonetti and Tigani Classification have shown substantial inter- and intra-observer agreement, and the "4B" subclass of Leonetti and Tigani CT-based classification showed a predominance in the present study.

Ultrasound guided versus landmark guided corticosteroid injection in patients with rotator cuff syndrome: Randomised controlled trial.

OBJECTIVE: Impingement syndrome is the most common differential in a patient presenting to an orthopaedic OPD with shoulder pain. Impingement syndrome is often managed with subacromial corticosteroid injection, which can be instilled using either landmark guided (LMG) approach or with the assistance of ultrasound (US). This study was envisaged to enquire whether ultrasound assistance improves the accuracy, efficacy or safety profile of the injection. METHODS: 60 patients of rotator cuff syndrome underwent diagnostic ultrasound. They were randomly assigned to receive subacromial injection of 2 ml (40 mg/ml) methylprenisolone and 2 ml of 1% lignocaine combination either by US assistance (n = 30) or using LMG assistance (n = 30). The patients were evaluated before injection and on follow up visits at day 5, week 3, week 6 and 3rd month by a single assessor. The assessor was blinded of the treatment group to which patient belonged. Clinical assessment included demographic and clinical data, accuracy of injection, VAS (0-100) for pain, Constant score with goniometer evaluation of range of motion, patient's self assessment proforma and post injection side effects if any. RESULTS: Initial demographic, clinical and US findings in the groups exhibited no significant differences. The accuracy of US guided injections (100%) was more when compared from LMG injection (93.3%). Both VAS and Constant score showed significant improvement following steroid injection up to 3 months of follow up. However the differences in the two groups were not significant suggesting comparable efficacy of the two approaches. (Mean VAS score decrease: 27.23 for US and 25.16 for LMG, p < 0.05: Mean constant score change: 14.73 for US and 15.00 for LMG, p < 0.05). The safety profile in both groups was comparable. CONCLUSION: Although US guided injections have a higher accuracy of drug placement in the subacromial bursa, there is no difference in terms of clinical outcomes or safety profile of either of the method. Hence US guided injections seems to be unjustified, when compared to equally efficacious and cost effective LMG steroid injection.