Shashi Kumar Nanjayan

Arachnoiditis Following Caudal Epidural Injections for the Lumbo-Sacral Radicular Pain

Caudal epidural steroid injection is a very common intervention in treatment of low back pain and sciatica symptoms. Although extensively used, it is not devoid of complications. A few reports of chemical and infective arachnoiditis exist following lumbar epidural anaesthesia, but none following a caudal epidural steroid injection.We report a case of arachnoiditis following caudal epidural steroid injections for lumbar radiculopathy. The patient presented with contralateral sciatica, worsening low back pain and urinary retention few days following the injection, followed by worsening motor functions in L4/L5/S1 myotomes with resultant dense foot drop. Gadolinium-enhanced magnetic resonance imaging suggested infective arachnoiditis with diffuse enhancement and clumping of the nerve roots within the lumbar and sacral thecal sac. As the number of injections in the management of back pain and lumbo-sacral radicular pain is increasing annually, it is imperative to have a thorough understanding of this potentially dangerous complication and educate the patients appropriately.

Trabecular Metal Patella — Is it really doomed to fail in the totally patellar-deficient knee? A case report of patellar reconstruction with a novel technique

Reconstruction of the patella poses real problems for the revision TKR surgeon, particularly when the patella is absent, fractured or profoundly deficient. The trabecular metal patella was introduced in an attempt to address these issues. However the largest series of such cases published to date cast serious doubts on the validity of using Trabecular Metal (TM) in cases where there is no residual patellar bone stock at all. We present a case where the TM Patellar implant has survived satisfactorily for 8 years post reconstruction in a knee with no residual patella bone, resulting in greatly improved symptoms and function. We believe that this success might be related to specific technical details in the reconstruction and we present the technique.

Total Dislocation of the Talus A Case Report

Total talar dislocation is a rare injury that is usually open. We report a case of closed anterolateral dislocation in a 19 year old, following a fall from a bicycle. He was treated with prompt closed reduction. A magnetic resonance imaging scan 6 months later showed no signs of avascular necrosis. At 2 years follow-up, the patient had a full, pain free, range of motion at the ankle and subtalar joints. Levels of Evidence: Therapeutic, Level IV: Case Study

Discharge destination and rehabilitation following neck of femur fractures in patients living in their own home

Introduction There is conflicting evidence in the literature regarding outcome of patients living in their own home prior to a fracture neck of femur, when using discharge destination and rehabilitation as measures of outcome. We investigated the factors predicting outcome following neck of femur (NOF) fractures, in patients previously living in their own home Method Medical records of all 292 patients admitted to Royal Derby Hospital between January and October 2010 with a fractured NOF (who lived in their own home prior to admission) were obtained retrospectively. Data included patient demographics; type of surgical intervention; mobility status and level of independence before admission; nature of fracture and patients9 ASA grade. Outcome measures including: number of days spent in hospital; number of days spent in rehabilitation; mortality; mobility on discharge; and discharge destination, were also sought. Data was analysed using SPSS Version 18. Results On discharge from the trust 101 (34.6%) patients returned to their own home. Twelve patients died before discharge from the trust. 5 patients (1.7%) needed nursing home care and one patient (0.3%) needed residential home care. Prior to their fracture 164 (56.2%) patients were able to walk indoors with no aids, which dropped dramatically to four (1.4%) patients at discharge.150 patients needed a median number of 28 days of extended rehabilitation period. Higher pre-operative ASA grades were associated with a higher median number of days spent in hospital Conclusion A delay in surgery due to the patient being medically unfit was associated with a longer hospital stay, delay in surgery for administrative and logistical reasons however did not increase the median number of days spent in hospital. A longer extended rehabilitation period was associated with internal fixation with DHS/IM Nail, a higher pre-operative ASA grade, and a greater number of days from fracture to mobilisation.