Raj Kumar Meena

A hospital based study of olecranon fracture treated by the figure of eight tension band wire loop without using kirschner's wire

Aims: To determine the treatment outcome of Olecranon fracture by open reduction and internal fixation using figure of eight tension band wire loop without kirschners wire and to assess the association between Olecranon fracture and selected variables of interest. Materials and Methods: Patients with Olecranon fractures Mayo type IIA were managed with tension band wire loop without kirschners wire. Final result assessed at 12 weeks. Clinically and radiologically as regard to pain, range of movement, status of union and function. Results: Twenty patients (m: 13, f: 7) with a mean age of 39.7 were operated. They were assessed at 12 weeks. Final result was Excellent in 14 patients (70%). Good in 3 patients (15%) and Fair in 3 patients (15%), using Mayos elbow performance score. There were 2 patients with stiffness and 1 patient with hypertrophied scar post-operatively. Conclusion: Olecranon fractures Mayo type IIA managed with tension band wiring using figure of eight wire loop without kirschners wire results in improved patient oriented outcome, improved surgeons oriented outcome, earlier return to function and decreased rate of non-union and the possible complication could be prevented by subjecting to open reduction and internal fixation in time.

Prevalence of piriformis syndrome among the cases of low back/buttock pain with sciatica: A prospective study

Aim: The aim of this study was to find out the prevalence and causes of piriformis syndrome in patients with complain of low back pain/buttock pain with sciatica attending Regional Institute of Medical Sciences (RIMS), Imphal. Materials and Methods: All the patients in the study group attending Orthopedic and Physical Medicine and Rehabilitation Out-patient Department in RIMS, Imphal were examined. Those with increased symptoms on sitting, localized significant tenderness on palpation of the muscle, presence of one or more of the following tests: Freiberg, pace, beatty, and FAIR (Flexion , Adduction and Internal Rotation) maneuvers with negative X-ray, ultrasound, computed tomography and magnetic resonance imaging findings were subjected to piriformis muscle injection of lidocaine (2%) 2 ml and methyl prednisolone 2 ml (40 mg) for confirmation of diagnosis. Result: Out of 2910 patients, 182 cases (M: 28, F: 154) in the age range of 19-75 years with a mean age of 43 years were clinically diagnosed as piriformis syndrome. Prevalence of piriformis syndrome was 6.25%. Conclusion: Piriformis syndrome is one of the differential diagnoses of low back/buttock pain with Sciatica. Individuals of all activity levels can be affected. Females are more affected than males. Causes are overuse, prolonged sitting, trauma, and vigorous massage. Diagnosis is by exclusion of other causes. Simple injection with local anesthetic and steroid in the piriformis muscle is both therapeutic and confirmatory of diagnosis. Early diagnosis and treatment with injection of piriformis muscle can prevent further complications and risks of surgery, which is also not 100% curative. With proper care, piriformis injection can be carried out without any complication. Long-term study is needed to evaluate the recurrence after injection treatment.

Internal fixation of adult diaphyseal both bone forearm fractures using locking compression plate

Introduction: Fractures involving the bones of forearm may result in severe loss of function unless adequately treated. The aim of this prospective study was to evaluate the outcomes of locking compression plate (LCP) for the treatment of adult diaphyseal both bone forearm fractures. Materials and Methods: This study conducted in the Department of Orthopedics, Regional Institute of Medical Sciences (RIMS), Imphal from September 2010 to June 2013 included 36 patients with 72 fractures. Operative time, callus formation, functional outcome, and complications were recorded. Results: Mean operative time forthe LCP fixation was 70.25 min. The time for callus formation and mean time to bone union was significant. However, overall functional outcome was good. One patient developed superficial infection. Conclusion: In this prospective study involving fixation of diaphyseal both bone forearm fractures using LCP, the outcomes were good in terms of final functional outcomes, mean operating time, callus formation, and mean time to bone union.

Fasciocutaneous flap as a method of soft tissue reconstruction in open tibial fractures

Objective: To study the role fasciocutaneous flap as a method of soft-tissue reconstruction in open tibial fractures soft-tissue defect and to compare their outcome when used as early coverage with that of delayed coverage. Materials and Methods: A total of 30 patients with open tibial fractures (type IIIB) were subjected to fasciocutaneous flap for the soft-tissue defect. Patients were divided into two groups based on the timing of soft-tissue reconstruction comprising of 15 patients in each group. Group I the early group (0-7 days) and group II delayed group (8-30 days). Results: Road traffic accidents accounted for the majority of fractures with 77.7% and 60% in group I and group II. The right leg was involved in 20 patients (66.7%) and left leg in 10 patients (33.33%). Middle one-third of the leg being the predominant site of wound defect 66.7% and 60% in group I and group II respectively. 66.7% of superficial infection was found with the delayed closure (group II) and 46% with early closure (group II). 26.7% of deep bony infection was found to be with the delayed closure and 20% with early closure. 80% of flap survived completely in group I while 73.3% flap survived in group II. In group I the time to union was between 13 weeks and 25 weeks accounting for 73.3% of the cases and in group II the time to union was between 26 weeks and 52 weeks, which accounted for 80% of the cases. The average hospital stay was 13.4 days in group I with 80% ranging in between 10 days and 20 days and in group II the average stay was 22.8 days with 53.3% ranging from 21 days to 30 days. Conclusion: The goals of soft tissue coverage in open fractures are to achieve a safe and early durable coverage, avoid nosocomial infection and optimize the healing and facilitate the future reconstruction. fasciocutaneous flap can reliably and effectively cover traumatic open tibial fractures soft tissue defect.Advantage of fasciocutaneous; they have their own blood supply producing a good durable cover and can be reopened for bony surgery.

A prospective study comparing locking compression plate with limited contact dynamic compression plate for the treatment of adult diaphyseal both bone forearm fractures

Introduction: Fractures involving the bones of forearm present unique problem not encountered with fractures of other long bones . The aim of this prospective study was to evaluate and compare the outcomes of locking compression plate (LCP) with limited contact dynamic compression plate(LC-DCP ) for the treatment of adult diaphyseal both bone forearm fractures. Material and methods: This study conducted in the Department of orthopaedics , Regional Institute Of Medical Sciences, Imphal from september 2010 to august 2012 included 20 patients with 40 fractures in each group . Patients were selected randomly to receive either LCP ( 20 patients , 40 fractures ) or LC-DCP( 20 patients , 40 fractures ) . Operative time , callus formation , functional outcome and complications were recorded. Results: Mean operative time did not differ significantly in the LCP and LC-DCP group ( 71.25 and 75.70 minutes respectively ) .There was some difference in callus formation and mean time to bone union between the two groups which was significant . However, overall functional outcome did not differ significantly between both the groups. One case had delayed union in the (LC-DCP) group while one patient in each group developed superficial infection. Conclusion: In this prospective study comparing LCP with LC-DCP , the outcomes were equal in terms of final functional outcomes and mean operating time but LCP showed slight advantage in terms of callus formation and mean time to bone union.

Giant dermatofibroma - a rare clinical variant

Dermatofibroma , also known as benign fibrous histiocytoma is a soft tissue tumor that usually occur in the mid adult life and shows a slight female predominance. Giant dermatofibroma , a very rare clinical variant is characterised by its unusually large size , benign biological behaviour despite its large size and same histopathological characterstics as conventional dermatofibroma .. We report a case of a 20 years old female presenting with a rapidly enlarging large mass in right leg in calf muscle region with history of progressive enlargement for past 4 years. The mass measured 13cm in greatest dimension. The patient underwent total excision of the tumor with wide local margin and histopathological examination confirmed it to be Giant dermatofibroma. Microscopic picture showed fibroblastic proliferation with collagen production , histiocytes and storiform pattern and focal lymphocytic infiltrates. Regular follow up showed no recurrence .This case is reported due to its very rare occurance , academic interest and to differentiate giant dermatofibroma from other such conditions such as desmoid tumor and dermofibrosarcoma protubens .