Mahendra Gudhe

Outcome analysis of obesity in trauma surgery related to closed injuries of lower limb in orthopedic surgery.

Background: Obesity is fast becoming a global epidemic and has profound effect on lower limb trauma surgeries is not well defined. This study aimed to evaluate and investigate the influence of obesity on health related quality of life (HRQL), patient reported outcome, incidence of postoperative surgical site infection (SSI), perioperative and postoperative complications. The specific association of obesity and outcome is not examined and measured previously in trauma surgery of lower limbs. Methods and Materials: During 2005 to 2014, a total of 12853 patients underwent different lower limb trauma surgeries and outcome measurement was based according to Body Mass Index (BMI). 10885 Patients with BMI of < 30kg/m2 were classified as non-obese and used as control groups. 1968 Patients with BMI of ≥ 30 kg/m2 were classified as obese and data analyzed in terms of outcome, adverse effects, complications and health related quality of life (HRQL) Results: The Increase in BMI leads to increased perioperative complications in terms of Intubation difficulty, blood loss, and duration of surgery. The post-operative adverse incidences in early period like deep venous thrombosis (DVT), surgical site infections (SSI), cardiac and renal events, superficial and deep infections were significant statistically. The delayed adverse effects relate to complications like late development of surgical site infection (SSI), implant loosening and orthopedic implant failure, re-operation rates for different complications. The improvement in health related quality (HQRL) is low among obese patients. Conclusions: Obesity has an inverse influence on patient outcome as compared to non obese patients. However, despite these increased obese patients do benefit from trauma surgeries of lower limb and patient reported outcome was found to be slightly lower among obese patients

Prevalence of Osteoporosis in Female Population in Rural Central India [By Calcaneal Ultrasound]

Introduction: Osteoporosis poses a huge challenge in India, as it is a developing country due to demographic transition and aging of the population along with limited resource availability in rural India. Worldwide, osteoporosis predominantly affects postmenopausal women, and elderly population of both gender. Previously osteoporosis has been primarily considered of disease of postmenopausal women. The exact disease burden is difficult to quantify because of the limited data availability along with difficult quantification of magnitude of the problem. The World Health Organization [WHO] has developed an algorithm for estimation of ten year fracture risk, which may be used even in the absence of bone mineral density. Smoking or tobacco intake, malnourishment, alcohol has a negative effect on bone mineral density [BMD]. Purpose: The aim of this study is to evaluate osteoporosis screening of the rural female population to establish correlation of osteoporosis with age group and socioeconomic strata of the patients. Methods and Material: A total number of 3532 rural female patients were screened and graded accordance to their demographic profile and socioeconomic strata. All the patients were screened for osteoporosis using a portable heel ultrasound bone densitometer. In all the female patients bone mineral density [BMD] was measured. Results: Results showed significant population had lower BMD score, which suggest osteoporosis and had statistical significant correlation with their socioeconomic, literacy and emotional family backup. However, we found that the prevalence of osteoporosis was homogenous in all the age group.

Ultrasound-guided platelet-rich plasma infiltration: A stupendous treatment for chronic tendinopathy

Background: Tendinopathy is a common and perplexing problem facing clinicians. It is the most common reason that patients seek medical attention for a musculoskeletal condition and accounts for approximately 30% of patient visits to general practitioners. Although originally considered an inflammatory problem, histopathologic analysis of tendinopathy has revealed evidence that this process is predominantly degenerative and is characterized by hypercellularity, vascular hyperplasia, and collagen disorganization. Since tendinopathy is primarily a degenerative condition, several new treatments have been developed in an attempt to stimulate tissue regeneration. One of these treatments is an injection of platelet-rich plasma (PRP). Materials and Methods: This is a prospective study conducted in the Department of Orthopaedics on outpatients having tendinopathies. These patients were managed with PRP infiltration at the tendinopathy site. Current proposed sample size in the study is sixty patients between the age of 21 and 65 years. The patients who are clinically diagnosed were given PRP at the tendinopathy after identifying the site under ultrasound guidance. Patients were assessed according to the visual analog scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) score pre- and post-injection. Results: Patients in the fourth decade had major preponderance. Male gender was dominant with the problem of tendinopathies. Supraspinatus tendinopathy was most common among all tendinopathies. Comparison of VAS with each follow-up showed 22.5% decrease in 1 st week and 58.58% relief in 4 th week. After evaluation using DASH score, there was 7.23% improvement in 1 st week, 12.43% in 4 th week, and 57.63% in 24 th week. Conclusion: The current investigation represents clinically based outcome study to evaluate the effectiveness of treating tendinopathy with ultrasonography-guided PRP injection. There is reduced the risk of infection, better improvement regarding pain, restoration of mobility, and duration of time required for clinical improvement. None of these patients reported with the recurrence of symptoms when followed up after 6 months of treatment.

All Anterior Dislocation - A Unique Injury

Bilateral shoulder Dislocations with ipsilateral hip dislocation is a very rare entity. To our knowledge not a single case has been reported with this type of injury. We report a case were the anterior dislocation trio occurred one after the other in an unusual mechanism of injury.

Volar plating in distal end radius fractures and its clinical and radiological outcome as compared to other methods of treatment

Background: Fracture of the distal end radius constitutes one of the most common skeletal injuries treated by the orthopedic surgeon. Wide arrays of techniques have been described including closed reduction, percutaneous fixation and open methods of reduction, and stabilization. Displaced extra- or intra-articular distal radius fractures require accurate reduction to allow a good outcome. We assessed the outcome of volar plate osteosynthesis and compared its outcome with other methods of treatment to confirm satisfactory reduction and functional outcomes. Materials and Methods: Prospective study conducted in our medical institution between 2012 and 2013. Inclusion criteria included skeletally mature patients who presented to casualty with fractures of the distal radius. Closed reduction cast application/K-wire fixation/open reduction and internal fixation with a volar plate was done under general anesthesia in 60 patients (20 cases each). During the follow-up, radiological and functional parameters were assessed and Gartland and Werley scoring was done. Results: Patients with volar plate fixation had a better outcome than the K-wire fixation and cast application. Radiological parameters were well-maintained, and functional parameters showed a significant improvement during the follow-up period. The complication rate was less and insignificant. 
Conclusion: Primary volar plate fixation of unstable distal radius fracture provides a stable construct that helps in early mobilization, thereby better functional outcomes and minimizes chances of delayed/malunion and, thereby is an upcoming method of choice for fracture distal end of radius. The present study comprised of 60 patients of distal radius fractures in 20 patients treated by plating, 20 by cast application and 20 by K-wire application. The minimum follow-up was 8 weeks, and the maximum was 36 weeks. This study was undertaken to assess the functional outcome of operative management of distal radial fractures and the following conclusions were drawn - male patients predominated female patients (36 males to 24 females) and average age of patients is 46.01 years. Left sided fractures were more common (61.6%). Road traffic accident was the commonest cause of the trauma (73.3%). AO 23 A-2 was the most common type of fracture, accounting for (26.6%) with Associated injuries seen in 4 patients (6.6%). Functional outcome as per Gartland and Werley was 3.75 for plating, 8.6 for cast application, and 7.55 for K-wire fixation. About 90% excellent to good results were observed in plating group as compared to 55% in cast and 65% in K-wire fixation in demerit score. Complication such as irregular articular surface, wrist pain, finger stiffness, K-wire loosening was observed. Thus, based on this study, we conclude that volar plating has relatively better outcome for distal end fractures of radius particularly volar Barton fractures, with minimum chance of loosening of implant even in highly comminuted cases and cases having osteoporosis.

Chondromyxoid fibroma of the distal one-third of the fibula: a rare tumour at rare site

Chondromyxoid fibromas are rare, benign tumours accounting for < 1% of primary bone neoplasms, and most commonly affected in the second or third decades of patients life. We reported one such case of chondromyxoid fibroma in the distal fibula of a 15-year-old girl. The patient was managed with lower 3 rd fibulectomy & fibular turnoplasty from middle 3 rd fibula with one-third tubular plate fixation for stabilization followed by bone grafting. The patient is disease-free since 3 years.

Clinical Effects of Autologous Platelet Rich Plasma in Tennis Elbow

Background: Platelet rich plasma has shown a major role in general stimulation for repair of soft tissue inflammatory diseases. Lateral epicondylitis is one of the most common clinical problems responsible for seeking medical advice especially in the sports clinic setting. This study was undertaken to evaluate the efficacy of local infiltration of non-activated Platelet Rich Plasma in chronic Tennis elbow. Material and Methods: This Prospective study for assessment of clinical effect of platelet rich plasma in tennis elbow was conducted from September 2013 to June 2014. Total 46 patients came with the complain of elbow pain in outpatient department were managed with ultrasound guided platelet rich plasma infiltration at the site of pain. Results: Male patients from 2nd and 3rd decade were mostly involved Age wise distribution shows second and third decade to have this data was taken for the patients only included in the current study. Most of our male patients were farmer or laborer whereas female were housewives. Students were also involved in our study. Dominant side was involved in 72% of the patients. Mean VAS score was improved at the end of follow up significantly. Conclusion: Platelet rich plasma can be an effective mode of treatment of chronic lateral epicondylitis.