Shraddha Singhania

Diagnostic Accuracy of Ultrasonography in Cases of Acute Appendicitis

Aims and objectives: To evaluate the accuracy of ultrasonography in the diagnosis of various pathologies of the appendix and to compare the findings of ultrasonography with surgical outcome. Materials and methods: All the patients suspected of appendicitis clinically were referred for ultrasonography. The accuracy of ultrasonography in the diagnosis of appendicitis was compared with surgical outcome. Results: Out of 50 cases who underwent ultrasonography, 37 cases were sonographically positive for appendicitis and 13 cases were appendicular masses. Right iliac fossa tenderness, rebound tenderness, and Rovsing’s sign were the cardinal signs. The overall specificity and sensitivity were 95% in the diagnosis of acute appendicitis. Conclusion: Ultrasound is the first-line method in patients referred with clinically suspected acute appendicitis and is cost-effective and reduces the cost of treatment of expensive procedures like exploratory laparoscopy and computed tomography abdomen.

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.