Amit Nandan Mishra

Analysis of the functional results of arthroscopic Bankart repair in posttraumatic recurrent anterior dislocations of shoulder

Background: The Bankart lesion represents the most common form of labro-ligamentous injury in patients with traumatic dislocations of the shoulder leading to shoulder instability. We report the clinical outcome of arthroscopic repair of Bankart lesion in 50 patients. Materials and Methods: Sixty five patients with posttraumatic anterior dislocation of shoulder were treated by arthroscopic repair from Jan 2005 to Nov 2008. Fifty patients, with an average age of 26.83 years (range 18-45 years), were reviewed in the study. The average followup period was 27 months (range 24-36 months). University of California Los Angeles shoulder rating scale was used to determine the outcome after surgery. The recurrence rates, range of motion, as well as postoperative function and return to sporting activities were evaluated. Results: Thirty six patients (72.0%) had excellent results, whereas seven patients (14.0%) had good results. The mean pre- and postoperative range of external rotation was 80.38° and 75.18°, respectively. Eighty-six percent patients had stability compared with the normal sided shoulder and were able to return to sports. There were no cases of redislocation observed in this study; however, three cases had mild laxity of the joint. Conclusion: Arthroscopic Bankart repair with the use of suture anchors is a reliable treatment method, with good clinical outcomes, excellent postoperative shoulder motion and low recurrence rates.

A comparative study of displaced midshaft clavicle fracture managed by precontoured locking compression plates and titanium elastic nails

Background: Results of conservatively managed mid-shaft clavicle fractures are not as good as previously thought. This has lead to increasing interest in primary fixation of these fractures. There are two main techniques of internal fixation, namely, plate fixation and intra-medullary nail fixation. We have evaluated pre-contoured locking compression plates and titanium elastic nails for fixation of midshaft clavicle fractures and compared their results Material and Methods: Between July 1 2015 and June 3

An evaluation of role of intraarticular hyaluronic acid in treatment of osteoarthritis of knee

Objective: To evaluate the role of intraarticular hyaluronic acid in treatment of osteoarthritis of knee among the patients admitted in a north Indian hospital. Methods: This was a prospective study conducted on 80 patients attending the out patient department of the hospital with a diagnosis of osteoarthritis of one or both knees were enrolled in this study. All the patients were symptomatic for osteoarthritis of knee and did not respond adequately to conservative treatment for osteoarthritis. 3 patients were lost to follow-up. The results are finally presented on 96 knees of 77 patients who underwent series of 5 intraarticular injections of hyaluronic acid at weekly interval. Results: The mean age of patients was 59.13 ± 2.3 years. Duration of symptom ranged from 6 months to 5 years. Most of the knees (55.2%) had moderate grade of osteoarthritis. The pain at rest and joint tenderness were significantly (p=0.0001) lower among mild grade of osteoarthritis as compared to moderate and severe. There was significant effect of intraarticular myaluronic acid in decreasing VAS and joint tenderness from baseline to 6 month. Conclusion: Visco-supplementation with hyaluronicacid may be considered an alternative option to major surgical procedure in developing countries provided the injections are given before mechanical changes take place and patient complies with regular exercise, weight control and postural habits.

A study of clinical evaluation of effectiveness of hydraulic distension of shoulder in the management of frozen shoulder

In this study we aim to evaluate clinical evaluation of outcome of treatment of frozen shoulder by hydraulic distension under local anesthesia with steroid. A rapid, immediate result and cost effectiveness of hydraulic distension technique was also evaluated is this study. There were 22 shoulders with good results after distension and 26 good results at follow up. In total there were 19 shoulders with excellent results at follow up, as compare to 2 shoulders with excellent results after distension. Patients who had detoriated revealed that they had failed to do regular prescribed home exercises. In contrast patients who had gained excellent results had their regular home exercises as prescribed to them. Hydraulic distension is a safe, reliable, cost effective modality in treating the chronically distressing painful condition of frozen shoulder.

Functional outcome of different treatment methods in fingertip injuries: A prospective study

Background: Various treatment modalities are used from the past to treat fingertip injuries. The common methods used are suturing, skin grafting, flap coverage of the wound by different techniques. This study reports the outcome of different treatment methods used in management of fingertip injuries. Material and Methods: In a prospective study from 15 August 2006 to 31 March 2008 we included 103 patients out of which 10 patient lost in follow-up. Average age of distribution is 39.6 yrs. Patients are divided in to four treatment groups and were followed for 6 months. Assesment of results were done on basis of tip tenderness, Colour of tip with surrounding tissue, stiffness in DIP joint, sensation, aesthetic look. Results: In our series we found that a total of seventy four patients had good and excellent relief of tip tenderness after 6 month of having the definitive surgery done, a total of sixty nine patients had good and excellent result as far as tip sensation is concerned, of sixty nine patients had good and excellent result as far as tip sensation is concerned, of sixty seven patients had good and excellent result as far as cosmesis is concern after 6 month post operatively. Conclusion: Conservative management was more successful in paediatric age group than in adult age group. Maximum relief in tip tenderness, Sensation found in homodigital /local flap group. Best result of cosmesis was in grafting group and worst in distant flap group. Thenar flap was useful in middle and index finger.

Clinical study of functional outcome of intertrochanteric fracture treated by Trochanteric fixation nail (TFN) in North Indian population: A prospective study

Background: Trochanteric fixation nail (TFN) is a newer device used for the treatment of the intertrochanteric femoral fracture. This study reports the outcome in such fractures treated by using the TFN at northern part of India. Materials & Methods: In a prospective study from October 2014 to September 2016, we included 64 patients (38 female, 36 male; mean age 59.25years; range 21 to 80 years) who were treated with the TFN for intertrochanteric hip fractures and followed up minimum of six months. According to the AO/OTA classification, there were 14 cases of type 31A1, 42 cases of type 31A2, and 08 cases of type 31A3 fractures. The patients were evaluated clinically (Harris hip score) and radiographically for a minimum period of six months with all complications were recorded. Results: In our series, most of the patients sustained trauma after simple fall (87.5%) and 12.5% as a result of road traffic accident (RTA).Fractures were classified according to AO/OTA classification, 14 patients had 31-A1 type of fracture, 42 had 31-A2 type of fracture and rest 8 had 31-A3 type of fracture. Mean average delay for surgery was 11.56 days (range 3 to 27 days). Out of 64 patient post-operative radiograph showed near anatomic reduction in 60 patients. We found 6 cases of intraoperative complication in the form of 2 cases of fixation in varus and 4 cases of loss of reduction. We found 8 cases of post-operative complication in which 2 cases of superficial and deep wound infection and 6 cases of varus malunion. No fractures of the femoral shaft, Z-Effect and reverse Z-Effect were noticed. We did not encountered any case of implant failure or avascular necrosis of femoral head. All the patient shows radiological union in our study with mean time of union was 11.02 weeks (12-18 weeks). According to harris hip score, we had good to excellent results in 88%, fair to poor result in 12% of cases. Conclusions: With proper patient selection, good instrumentation, image intensifier and surgical technique, TFN is a good choice in the management of intertrochanteric fractures leading to high rate of bone union and good functional result with minimal soft tissue damage.