Chandrashekhar Yadav

Dextrose prolotherapy for recalcitrant coccygodynia

Purpose. To present the results of dextrose prolotherapy undertaken for chronic non-responding coccygodynia in 37 patients. Methods. 14 men and 23 women (mean age, 36 years) with chronic coccygodynia not responding to conservative treatment for more than 6 months were included. 27 of them had received local steroid injections. A visual analogue score (VAS) was recorded for all patients before and after injection of 8 ml of 25% dextrose and 2 ml of 2% lignocaine into the coccyx. In 8 patients with a VAS of more than 4 after the second injection, a third injection was given 4 weeks later. Results. The mean VAS before prolotherapy was 8.5. It was 3.4 after the first injection and 2.5 after the second injection. Minimal or no improvement was noted in 7 patients; the remaining 30 patients had good pain relief. Conclusion. Dextrose prolothearpy is an effective treatment option in patients with chronic, recalcitrant coccygodynia and should be used before undergoing coccygectomy. Randomised studies are needed to compare prolotherapy with local steroid injections or coccygectomies.

Evaluation of pain in bilateral total knee replacement with and without tourniquet; a prospective randomized control trial

AIM Thigh pain following tourniquet application is a common complaint in early post operative period following total knee arthroplasty. METHOD Post operative Thigh pain was evaluated in 30 consecutive simultaneous bilateral total knee arthroplasty patients between July 2013 and January 2014. Patient thigh pain was evaluated with the VAS score. The scale was applied on first, second, third day & second and six weeks after surgery. RESULT There were statistically significant difference in VAS score in non-tourniquet group on first, second, third post operative day. We did not find statistically significant difference at Second and Six weeks post operatively. CONCLUSION This Randomized trial demonstrates that non-tourniquet use in TKA has less early postoperative pain and leads to better recovery.

Computed Tomography–Guided Radiofrequency Ablation of Osteoid Osteomas

Purpose. To report on 14 patients with osteoid osteomas treated by computed tomography–guided radiofrequency ablation. Methods. Nine males and 5 females aged 13 to 45 (mean, 25) years with osteoid osteomas were included. The proximal tibia was the commonest site involved. A bipolar 18-gauge radiofrequency probe with a 9-mm active tip was used. A 4.5-mm hollow drill was introduced into the nidus. Energy application was started at 2 W and increased to a maximum of 5 W. Heat was applied for 4 to 6 minutes at 90 degrees Celsius. Results. 12 (86%) of the 14 patients had prompt pain relief; the remaining 2 underwent a repeat ablation. After a mean follow-up period of 19 (range, 9–25) months, no patient had pain recurrence. Conclusion. Radiofrequency ablation is a minimally invasive and cost-effective treatment for osteoid osteomas.

How to interpret postoperative X-rays after total knee arthroplasty.

Today, total knee arthroplasty (TKA) is one the most commonly performed surgeries worldwide. The purpose of this article is to review the appearance of normal post‐TKA roentgenographs and describe the correct sequence for their interpretation. It is unwise to depend solely on patients’ symptoms when diagnosing TKA complications because serial radiographs can foresee failures well before they manifest clinically. Ideal post‐TKA radiographs comprise whole lower extremity anteroposterior and lateral views taken under weight bearing conditions along with a skyline view of the patellofemoral joint. Among other things, weight bearing exposes the true alignment, ligamentous laxity and polyethylene wear. On the basis of follow‐up of our TKA cases, we have drawn up a protocol for assessing postoperative X‐ray films after TKAs. Following the proposed sequence, surgeon can easily decide how to proceed with follow‐up and foresee complications. Careful interpretation of postoperative radiographs after TKA is essential to careful monitoring of patients and implant survival.

Total Joint Replacements in Hip and Knee Ankylosed in Gross Flexion: Case Report

Total knee and hip replacement have been very successful surgeries and the indications for these are extending daily. We are presenting the case of an adult female who was crippled due to severe deformity of her hip and knee joints and had her life improved tremendously after the surgery. However, the post-operative range of flexion and hip stability were not as good as those following primary hip replacement in joints that had not been ankylosed. Nevertheless, with proper planning and meticulous surgery, it is possible to provide stable and mobile joints to the patients and make their life way better. We suggest that all such patients should be given the option of replacement and few anticipated complications and outcome somewhat inferior to non-ankylosed joints, should not deprive them of the opportunity to make their lives self-reliant.

Delayed presentation of fracture of lateral condyle of humerus in pediatric age group treated by ORIF and ulnar peg grafting: A case series

Background: Fractures of lateral condyle of humerus in pediatric age group, the most common being distal humerus epiphyseal injury, are commonly associated with delayed presentation to terminal health care providers. Reasons accounted might be at every level, right from the patient to the physician. In the backdrop of existing disputed treatment strategy operative v/s non-operative treatment of fractures having more than 3-week duration of injury, same were treated by open reduction and k wire fixation using ulnar peg graft. Final functional result was evaluated with longest follow up of over 1 year. Materials and Methods: Twenty children having fracture of lateral condyle of humerus with duration of trauma more than 3 week were included in the prospective study. Age ranged from 5 years to 15 years. Average age was 8 years. Among the 20 patients, 8 were male and 12 were female. Average time of presentation was after 5 weeks of injury. Seven patients had milch type 1 injury and 13 patients had milch type II injury. All patients were treated by open reduction and internal fixation using k wires and ulnar peg graft. The follow-up period was over 1 year. Result: Results were evaluated using radiograph, and functional results were evaluated using the Liverpool elbow scoring system. In the present series, all fractures united with 92% excellent, 5% good, and 3% poor results. Poor results were associated with greater displacement of fracture, prior repeated attempts of close reduction, and history of massage. Conclusion: Being an epiphyseal injury and a common occurrence, fracture of lateral condyle of humerus in pediatric age group are commonly maltreated, with error contributed right from parents to even physician. Common reasons of delayed presentation are ignorance on parents′ side, malpractice by some bone-setters, poorly done radiograph, inaccurate radiographic interpretation by the physician, and poor selection of treatment methods.

Direct Repair without Augmentation of Patellar Tendon Avulsion following TKA.

Complications involving the extensor mechanism after TKA are potentially disastrous. We are reporting a case of patellar tendon rupture from tibial tuberosity following total knee arthroplasty. We managed it by direct repair with fiberwire using Krackow suture technique without augmentation. Our long term result has been very encouraging. Our method is a safe and better method of management of patellar tendon avulsion following TKA when it happens without any tissue loss.

Why we still punish school kids

Musculoskeletal injuries in children who were punished in school are unusual injuries. Literature is tacit about such injuries. Manners of punishment differ across the globe but none results in physical harm, culminating in musculoskeletal injuries. We report one such injury where school child was punished keeping an ink pen in between index and middle finger and pressing them thereafter, which resulted in a type II epiphyseal injury of proximal phalynx of index finger.