Sohael Khan

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

Hepatotoxicity and Changes in Liver Enzymes Due to Use of Non-Steroidal Anti Inflammatory Drugs (NSAIDs) in Non-Traumatic Musculoskeletal Painful Disorders

The present study aims at critical analysis and investigation of liver function test and hepatotoxity with use of NSAIDs in patients of Non- Traumatic musculoskeletal painful disorders. NSAIDs are most commonly used by medical fraternity worldwide for relief from acute, recurring or chronic pain conditions and are easily available in India in many forms over-the-counter analgesic, sometimes resulting in adverse drug reactions (ADR). The use of NSAIDs and gastrointestinal and renal disturbance is well known. The most frequent ADR due to NSAIDs use was gastrointestinal effects leading to discontinuation of treatment The liver plays a central role in drug metabolism. However, little is known about the cause and effect of NSAIDs on liver and liver enzymes. Most NSAIDs induce hepatic toxicity are due to individual patient susceptibility (idiosyncrasy), and intrinsic associated with mainly hepatocellular tissue. Hepatic toxicity response ranges from asymptomatic or transient derangement in liver function test to fulminant liver damage. The hepatotoxicity due to risk factors associated with NSAID toxicity must be kept in mind by physicians whenever prescribing NSAIDs, because much of underreporting is usually due to transient and asymptomatic effects on liver.

Gastrointestinal Adverse Effects due to Use of Non-Steroidal Anti- Inflammatory Drugs (NSAIDs) in Non-Traumatic Painful Musculoskeletal Disorders

Background: The present study aims at investigation of the gastrointestinal adverse drug reactions (ADRs) with use of NSAIDs in patients of Non-Traumatic musculoskeletal painful disorders. Our study is unique in terms that it aims at investigations and evaluations of the gastrointestinal adverse drug reactions (ADRs) with use of NSAIDs in patients of non-traumatic musculoskeletal painful disorders, where most of the concurrent and concomitant risk factors like hepatobiliary system, renal system are mostly excluded, along with a dedicated follow up of large population included in our study. Non-Steroidal anti-inflammatory drugs (NSAIDs) such as Diclofenac sodium, Ibuprofen and others are effective for non-traumatic musculoskeletal painful disorders ranging from acute to chronic conditions. NSAIDs are probably most commonly used medications by medical fraternity worldwide for relief from acute, recurring or chronic pain conditions and are easily available in India in many forms as over-the-counter analgesic. Prolonged unsupervised use of these medications leads to disturbance in achieving pain relief and risk of gastrointestinal symptoms ranging from dyspepsia to acute and chronic gastrointestinal ulcer. The most frequent ADRs due to NSAIDs use was gastrointestinal effects leading to discontinuation of treatment. The other ADRs for which NSAIDs are blamed widely are alteration of renal or cardiac parameters in a small subset of patients. Renal and cardiac side effects are well documented and evaluated by clinicians prior to administration of NSAIDs, but the gastrointestinal adverse reactions are overlooked by medical fraternity while

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.

Outcome Analysis of Enders and Other Elastic Nails in Diaphyseal Fractures of Tibia

Background: Enders nailing is a good modality of treatment especially because of its cost effectiveness, minimum use of image intensifier and simple technique with short learning curve. Flexible or elastic nails are used in specified fracture situations in tibia. Our study aims to confirm that Ender nails are still useful and can give good results in patients of tibial diaphyseal fracture with proper indication. Concerning the low cost and simple technique we aimed to demonstrate that Ender nails may provide satisfactory results in selected group of diaphyseal fractures of tibia. The aim of the study was to find out the outcome analysis of Enders and other flexible nails in the diaphyseal tibia fractures. Material and Methods: The present study was conducted in Department of Orthopaedics during the period of April 2015 to April 2016. This is a prospective and retrospective study. Post – operative the functional assessment was done and radiological evaluation was done. Results: The study was conducted between April 2015 and April 2016, total 20 patients of tibialdiaphyseal fractures were treated with enders and other flexible nails. 90% of the patients in the study were males, 85% had injury from RTA. 40% of the patients had open clinical type of fracture and 60% had close clinical type of fracture.35% of the patients with union time of 6-9 weeks and 15% with >17wks had full weight bearing 6 to 9 weeks, 5% of the patients with union time 6-9wks, and>17wks had 10-13 weeks. 50% of the patients had union time of 12-14 weeks, 25% had 15-17 weeks, 10% had 18-20 weeks and 10% had more than 20 weeks. Conclusion: In can be concluded that Enders nail can be good alternative for treatment of diaphyseal fractures if proper patient selection is done pre – op and patients are explained regarding the same.

Epidemiology of Delayed Union of Long Bones

Aim: To study the epidemiology of delayed union of long bones. Introduction: In India, the availability of fracture healing therapies to the general public is limited. The infrastructure of the health system in India, involving both public and private sector does not provide adequate opportunity for rural and low-income inhabitants to access the needed care. Due to these reasons, majority of the global burden of injuries are borne by low and middle-income countries. Material and methods: Patients getting admitted in AVBRH hospital above the age of 18 years of either sex with radiological features of delayed union. Study was a prospective, case control observational type carried out in a rural health setup at AVBRH. It comprised of 153 patients out of which 43 patients had delayed union of a long bone, 53 patients had non-union. These patients were compared with 57 patients that had postoperative fracture union which were included as a control group who had the same risk factors for delayed union. Results: Aging, female gender, comminuted and segmental fractures, higher grades of soft tissue injury, smoking, and infection were found to be independent risk factors for delayed union in long bone fractures. Among the risk factors, smoking and infection can be controlled to decrease the prevalence of delayed union. Conclusion: It is necessary that we create awareness about the importance of primary treatment like immobilization and wound debridement, as patients should reach as early as possible. Patient’s relative’s moral support is necessary in order to get early hospitalization so as to reduce the risk of delayed union among patients and so that appropriate modality of treatment (surgical and conservative) with use of bone regeneration substitutes such as bone grafting and PRP can be done to promote faster healing keeping infection in control.

The Role of Nursing Staff in Spinal Cord Injured Patients

Sohael M Khan1*, Kedar Phadke2, Pradeep K Singh3 and Shashank Jain1 1Department of Orthopedics, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India 2Department of Orthopedics, Vadodara Institute of Orthopaedics, Vadodara, Gujarat, India 3Department of Orthopaedics, Dr H L Hiranandani Hospital, Mumbai, Maharashtra, India *Corresponding author: Sohael M Khan, Assistant Professor and Consultant Spine Unit, Department of Orthopedics, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India, Tel: 9890310177; E-mail: drsohaelkhan@hotmail.com

Brachial plexopathy, whiplash injury, and fracture humerus: An unhappy triad

Clinical picture of brachial plexopathy may be overlapped by concomitant presence of ipsilateral fracture of humerus. Compound fracture of proximal shaft of humerus in high-energy road traffic accident may completely mask the feature of brachial plexus injury, especially when a patient is under the influence of alcohol. We are reporting a case that sustained compound fracture of proximal shaft of humerus with missed brachial plexus injury which was evident 3 weeks after the trauma. The best of clinical services can lead to excellent functional outcome but cannot avoid medico-legal consequences.

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.