Sudhir Singh

Risk factors in cervical spondylosis

BACKGROUND Cervical spondylosis is essentially a degenerative disorder common after fourth decade. It has been seen that radiological evidence of cervical spondylosis do not necessarily co-relate with clinical findings. This discrepancy has been attributed to the morphometric dimensions of the vertebrae, age, sex, race, occupation, weight and height of the patients. OBJECTIVE The objective of this study is to co-relate the variables like age, sex, race, occupation, vertebral body diameter, canal diameter, canal body ratio of cervical spine vertebrae with cervical spondylosis cases with normal population. METHODS In this hospital based, case control, consent based, cross-sectional, clinico-radiological study 200 individuals (controls-100, cases-100) who were subjected to lateral projection radiographs of cervical spine. Their age, sex, race, occupation, height, weight and mid-sagittal canal diameter (CD), sagittal vertebral body diameter (VBD) and the canal-body ratio (CBR) of the cervical vertebrae was recorded and analyzed statistically. RESULTS There was no relation between vertebral dimensions and clinical groups. In radiculopathy group, age and height showed significance on univariate analysis. While only age remained significant on multivariate analysis. In neck pain group age, sex, and height showed significance on univariate analysis while in multivariate analysis age, sex and occupation were significant risk factors.

Role of Hyaluronic Acid in Early Diagnosis of Knee Osteoarthritis

INTRODUCTION Osteoarthritis of knee is traditionally diagnosed on the basis of clinical and radiological findings. Usually joint tissue degeneration is already advanced by the time a clinical diagnosis is made, hence the research focus has now shifted to use of biomarkers to diagnose the condition at an early stage of the disease. AIMS & OBJECTIVES The aim of this study was to assess the efficacy of serum HA levels in early detection and grading of the severity of primary knee osteoarthritis and its co-relation with Western Ontario and McMaster university osteoarthritis index (WOMAC scores) and Kellgren -Lawrence grading (K-L grade). MATERIALS AND METHODS The study included 150 subjects (100 cases and 50 controls) and all were subjected to WOMAC scoring and K-L grading and estimation of serum HA levels. RESULTS Age and WOMAC scores have significant correlation with HA levels, but multivariate analysis shows only WOMAC score as an independent variable associated with HA levels. The results show statistically significant high HA levels in cases than in normal population. HA levels are also able to differentiate between various clinical severity grades. ROC Curve analysis suggests cut-off levels of HA between mild, moderate and severe cases. CONCLUSION HA levels are able to differentiate between normal asymptomatic population and symptomatic cases and also between various severity grades of osteoarthritis.

Serum Cartilage Oligomeric Matrix Protein: Tool for early diagnosis and grading of severity of primary knee osteoarthritis.

Context: With increasing elderly population there is increasing prevalence of primary degenerative knee osteoarthritis (KOA), but specific and sensitive tests to diagnose and ascertain the severity of such ailments are lacking. Bone and cartilage biomark ers, like serum Cartilage Oligomeric Matrix Protein (sCOMP) level show changes much before than clinical or radiological changes. So far it has not been used in clinical practice as the diagnostic range of serum COMP levels have not been defined. Aims: The aim of present study was to assess the efficacy of sCOMP levels in diagnosis of different grades of severity of primary knee osteoarthritis. Settings and design: A hospital based prospective case control study recruiting 100 cases and 50 controls. Methods and material: All subjects were examined clinically and further evaluated by plain radiography and serum COMP values were estimated by enzyme linked immune-sorbent assay (ELISA). Multiple statistical tools were used to analyse the results. Results: The difference between sCOMP values among cases and controls was statistically significant (t=21.774; p<0.001). The mean sCOMP also shows a gradual increase with increase in severity of knee osteoarthritis. [F=38.940; p<0.001 (ANOVA)]. Conclusions: The serum COMP levels can be used to diagnose normal and diseased individual and also assess different grades of severity of knee osteoarthritis. We suggest cut off levels of sCOMP of 652.5 nano gram/deci litre (ng/dl) between normal and diseased individual, of 801.5 ng/dl between mild and moderate grade of osteoarthritis, and of 1100.5 ng/dl between moderate and severe grade of knee Osteoarthritis (KOA).

Comparative Study Using Intramedullary K-wire Fixation Over Titanium Elastic Nail in Paediatric Shaft Femur Fractures.

BACKGROUND Fracture shaft femur is common paediatric trauma leading to significant morbidity. Conservative treatments available are associated with prolonged periods of immobilization. Use of flexible intramedullary implant allows early rehabilitation in diaphyseal fractures of femur in children. AIM The aim of the present study is to compare fixation of diaphyseal femur fracture by titanium elastic nail and intramedullary K-wires in children. SETTING AND DESIGN Prospective randomized study in a tertiary care hospital. MATERIAL AND METHODS Fifty-two children between 6 years and 14 years of age with femoral shaft fracture were assigned either in Group I or Group II based on computer generated random numbers. In Group I closed percutaneous intramedullary K- wire fixation and in Group II closed percutaneous intramedullary titanium elastic nail was used to fix the fractures. Partial weight bearing was allowed after 6 weeks of surgery and full weight bearing at clinico-radiological union. RESULTS Average time of radiological union was 6 to 10 weeks in both groups. In both the groups two cases had entry site irritation which resolved with early implant removal. One case in both the groups had unacceptable mal-alignment. Both the groups had few cases of limb-length discrepancy, which was in acceptable limit, except two cases of TENS. There was no statistically significant difference between the results of both the groups. But, using K-wires significantly reduced the cost of treatment. CONCLUSION Most of such fractures in our society are neglected because of high cost of treatment. Providing a cheaper alternative in form of K-wires may be beneficial for the patients from low socio-economic status.

Hemi Replacement Arthroplasty for Unstable Inter-Trochanteric Fractures of Femur

INTRODUCTION Unstable inter-trochanteric fracture in the geriatric population is a common injury and is associated with poor bone quality, excessive collapse, loss of fixation, and cut-out of the lag screw, are the common problems of attempts to fix these fractures. Present study is an attempt to evaluate the functional outcome of primary cemented bipolar hemiarthroplasty in unstable inter-trochanteric fractures in elderly patients. MATERIALS AND METHODS This prospective study included 25 cases with unstable inter-trochanteric fracture of femur between 60 -75 y of age in whom primary Cemented Bipolar hemi - arthroplasty was performed. The patients were followed up at six week, three month, six month and one year postoperatively and assessed using Harris Hip Score (HHS), Lower Extremity Functional Scale (LEFS), Visual analogue scale (VAS) for evaluation of outcome. RESULTS The mean HHS score was 78.86+8.13 by the end of one year. Similarly mean LEFS score was 34.36+7.01 by the end of one year, whereas the mean pain score on VAS Scale by the year end was 1.04+1.02. DISCUSSION The changes in HHS, LEFS and VAS up to six months periods are much greater which starts showing a stable trend thereafter. Fair to good scores were observed in all the patients. We compared our results with those reported by other authors and our study gave quite comparable results. We also used lower extremity function status score (LEFS) for assessment of functional ability. The purpose of its use was that while Harris Hip Score (HHS) provides information on a multitude of factors, LEFS is more patient oriented and provides the correct information about the level of activities a patient can resume post-operatively and can be offered as a self assessment tool. No significant complication except for grade I pressure sores in four patients were seen in postoperative period but they all resolved with proper nursing care by six week follow up. No patient required revision surgery. CONCLUSION The authors believe that primary cemented bipolar hemiarthroplasty for unstable inter-trochanteric fractures of femur in elderly does provide early ambulation, good functional outcome, pain free joint with minimal complications without the need for revision surgery.

A neglected case of Klippel Trenaunay Weber syndrome

This congenital vascular disorder is described by a “triad” of symptoms affecting one or more limbs. The “triad” constitutes varicose veins, cutaneous hemangioma, with bone and soft tissue hypertrophy. The cutaneous hemangioma presents as a substantial port-wine stain or nevus. Varicose veins are often very numerous. Bone and soft tissue hypertrophy is variable in presentation and the affected limb may be either larger or smaller than the normal limb. This disorder is generally reported in childhood or adolescent age groups. We herein present a neglected case of Klippel Trenaunay Syndrome with all the classical clinical and radiological findings. A 30-year-old man reported with the classical triad. On clinical examination substantial port wine stain was seen and radiographs showed multiple bony outgrowths whereas MRI showed multiple varicosities displaying heterogeneous hyper intense signals on T2 Weighted Images and T1 hypo intensity with hypertrophy of soft tissue in left lower limb.

Functional Outcome of Hemireplacement Arthroplasty done for Unstable Intertrochanteric Fractures of Femur in Elderly Patients: A Review

The incidence of hip fracture rises dramatically with increasing age. The Indian population appears particularly vulnerable to the problem of osteoporosis and hip fractures. It has been projected that by the next century 50% of all hip fractures in the world will occur in Asia. The treatment of such unstable intertrochanteric fracture is still controversial, despite the publication of reports of randomized trials and comparative studies. Excessive collapse, loss of fixation, and cut-out of the lag screw resulting in poor function remain problem associated with internal fixation of unstable intertrochanteric fracture in the elderly patient with osteoporotic bone. To allow earlier postoperative weight-bearing and to avoid excessive collapse at the fracture site, prosthetic replacement is recommended for the treatment of unstable intertrochanteric fractures, but has not gained widespread support. So, a review of functional outcome of prosthetic replacement for unstable intertrochanteric fracture was done which shows a good functional outcome, pain free joint with minimal complications.