Common Mode Of Injury Research Articles

Plantar plate rupture: aetiology, diagnosis and treatment

The fibrocartilaginous plantar plate is a key static stabilizer of the lesser metatarsophalangeal joints and disruption is associated with metatarsalgia which may progress to significant coronal and sagittal plane deformities, most commonly of the second toe. Chronic attrition is by far the most common mode of injury, though rupture can also occur in acute trauma or in association with erosive rheumatoid arthritis. Focal plantar pain and tenderness, positive drawer test, reduced plantar grip strength and lesser toe deformities are key clinical findings. Diagnosis may be further evaluated with plain radiographs and MRI. Clinical and surgical classification systems have been developed expressing the progression from plantar pain without deformity eventually leading to fixed crossover toe. A range of treatment options have been described in the literature including conservative options, osseous decompression techniques, anatomic plantar plate repair and tendon-transfers. There has been increased focus on anatomic surgical repair as a key treatment strategy over the last decade. Whilst promising results in terms of functional outcome are demonstrated in the literature at the short and mid-term, risks of postoperative stiffness and floating toe deformities should not be ignored when counselling patients regarding surgery and conservative treatment should remain first line.

A prospective study to evaluate the functional and clinical outcome of anterior cruciate ligament reconstruction with standard hamstring autograft

Background: The anterior cruciate ligament (ACL) is the primary stabilizer of the knee and prevents the knee against anterior translation. It is also important in counteracting rotational and valgus stress. The arthroscopically aided approach has the advantages of smaller skin and capsular incisions, improved viewing of the intercondylar notch for placement of the tunnel and attachment sites, less postoperative pain, fewer adhesions, earlier motion, and easier rehabilitation. The advantages with semitendinosus grafts are the availability of a greater sectional area and the unaffected integrity of the extensor mechanism. Moreover, the tensile strength of quadrupled hamstring is found to be even better than a normal ACL. The rate of complications such as extension loss, anterior knee pain, and surgical site infections was also lower than in other procedures such as in BPTB grafts. Cortical suspension devices have the necessary biomechanical properties with regard to ultimate failure strength, displacement, and stiffness for the initial fixation of soft tissue in the femoral tunnel for ACL reconstruction. The aperture fixation methods such as the interference screws allow for early firm fixation and heal with a tight bone–tendon interface.Objective: A prospective study to evaluate the functional and clinical outcome of ACL reconstruction with standard hamstring autograft.Materials and Methods: The study results included 30 patients admitted with clinical and radiological deficiency of ACL from September 2019 to March 2021 using endobutton and bioabsorbable interference screw in terms of range of motion, postoperative knee stability, subjective knee functions, and prospective assessment of functional outcome using Tegner Lysholm knee scoring system.Results: Sports injuries were the most common mode of injury (n = 17, 56.7%). The mean size of graft used was 8.2 ± 0.39 mm. Postoperatively at 2-year follow-up, 30 cases (100%) had 0 grade pivot-shift test, 0 grade Lachman test, and anterior drawer test. The mean postoperative Lysholm score improved from preoperative score of 62.83 ± 5.2–91.0 ± 5.54. The overall satisfactory result (excellent + good) at 6-month follow-up was (excellent – 30 and good – 70) 100%. Out of this, 27 (90%) patients had returned to preinjury level of activity in 1 year. In this study, one patient had superficial infection and two patients had knee pain.Conclusion: Arthroscopy-assisted ACL reconstruction using hamstring tendon autograft provides a stable knee, reduces postoperative morbidity, and enables early rehabilitation.

Clinicoepidemiological profile of necrotizing fasciitis in a tertiary care center of western Odisha

Background: Necrotizing fasciitis (NF) is a state of infection promptly intensifying the destruction of skin with underlying tissue leading to permanent infirmity and high mortality irrespective of good parenteral drug coverage and contentious surgical handling. NF normally begins as a confined infective focus that initially presents as cellulitis later rapidly progresses to large areas of infection which disproportionate to pain. Aims and Objectives: The primary aim of this study is to determine the incidence and management methods of NF in tertiary health-care center of western Odisha. Materials and Methods: A retrospective review of medical records of patients diagnosed with NF presenting to department of general surgery, Veer Surendra Sai Institute of Medical Sciences and Research Burla, from March, 2020 to February, 2022 was performed. Various information such as patient’s demographics, type of presentation at the time of admission, age group affected, body parts affected, mode of injury, and microbiological status were collected in a predesigned format for analysis. Data were presented in number and percentage. Results: A cumulative of 96 cases with clinical features of NF was reviewed. The median age group range was 31–40 years. Nearly 94.7% cases had significant underlying comorbidities. Extremities were most commonly affected part. About 82.2% cases had undergone surgical debridement, 13.5% cases fasciotomy, and 4.2% cases skin grafting. Most common mode of injury is trivial injury. Group A Streptococcus is most common cause of organism. Almost 78.3% cases were healed. Conclusions: NF can induce upscaled morbidity and mortality if left undetected and untreated in primordial stages. The medics, paramedics, and specialists including surgeons need to have a high degree of intuition to diagnose NF at its beginning stages and thus precisely put resuscitative efforts, plan for debridement, and need for any urgent referral.

Spectrum of paediatric blunt abdominal trauma in a tertiary care hospital in India.

To study the profile of paediatric blunt abdominal trauma and to assess the correlation of grade of injury with the outcome. It is a prospective observational study from January 2015 to December 2020. Children below 12 years with blunt abdominal trauma were included. Patient demographic data, treatment given and the final outcome were recorded. All patients were followed up for a minimum of 6 months to maximum 5 years. A total of 68 patients were included in the study. Fall from height was the most common mode of injury (62%) followed by road traffic accidents (35%) and the other causes included in the miscellaneous group (hit by animal and fall of heavy object on the abdomen; 3%). Most commonly injured organ was liver (n = 28, 41%) followed by spleen (n = 18, 26%) and kidney (n = 15, 22%). Other injuries were bowel perforations (jejunal [n = 4], ileal [n = 1] and large bowel [n = 1]; 9%), pancreaticoduodenal (n = 5, 7%), urinary bladder (n = 3, 4%), abdominal vascular injury (iliac vein-1, inferior vena cava-1;3%), adrenal haematoma (n = 2,3%) and common bile duct (CBD) injury (n = 1, 1%). More than one organ injury was seen in 13 cases (19%). Non-operative management was successful in 84% (n = 27) and laparotomy was done in 16% (n = 11). Most of the patients sustained Grade IV injury (n = 36, 53%) and majority of the patients (n = 60, 88%) had good outcome without any long-term complications. Profile of paediatric blunt abdominal trauma include solid organ injuries such as liver, spleen, kidney, pancreas, adrenal gland and others like bowel injury, CBD, urinary bladder and abdominal vascular injury. The grade of injury does not correlate with the outcome in a higher grade of injury and these children had good outcome.

Observational study of short-segment pedicle screw fixation for dorsolumbar spine injury: A prospective study

Background: Traumatic injury of dorsolumbar spine is one of the most common sites of spinal injuries because of its location between rigid kyphotic thoracic and mobile lordotic lumbar spine. Its treatment by pedicle screw fixation by short segment (one level above and below the fractured vertebra) or long segment (two levels above and below the fractured vertebra) has always remained a matter of debate. The aim of this study was to assess the functional outcome of short-segment fixation in dorsolumbar spine injury.Materials and Methods: This prospective study was conducted on thirty, single-level, unstable dorsolumbar spine fracture patients, who underwent short-segment pedicle screw instrumentation at Indira Gandhi Institute of Medical Sciences, Patna, between October 2019 and September 2021. All the patients were operated by posterior approach and stabilized the vertebrae with short-segment pedicle screw instrumentation. All patients were followed up for 1 year.Results: Thirty patients (21 males and 9 females) of mean age 34.2 ± 11.74 years were included in the study. The most common mode of injury was fall from height (24 patients, 80%), followed by road traffic accident (six patients, 20%). The most common fracture pattern was compression fractures in 23 (76.67%) patients, followed by burst fractures in 7 (23.33%) patients. The most common level of injury was L1, followed by D12. Neurological improvement of at least one level was seen in 21 patients, and nine patients had no neurological improvement. There was a statistically significant correction of kyphotic angle of 14.9°. At 1 year of follow-up, 21 (70%) patients had <40% Oswestry Disability Index (ODI) and 9 (30%) patients had more than 40% ODI. Out of 30 patients, 2 (6.67%) patients had bedsore, 1 (3.33%) patient had superficial infection, and 1 (3.33%) patient had implant failure.Conclusion: The short-segment posterior instrumentation system is a very stable construct. It maintained the corrected deformity after fracture reduction and spares the motion segment which is sacrificed in the conventional long-segment fixation. The soft tissue dissection, blood loss, and duration of surgery are less in this procedure.

Outcomes of single-stage reconstruction with ipsilateral peroneus longus and hamstring graft in multiligament knee injuries: A case series

Abstract Background: The diagnosis and management of patients presenting with more than one ligament injury in the knee have been a controversial topic for several decades and it is difficult to draw any firm conclusions. No single approach has proven optimal for the treatment of multiligament knee injuries (MLKI) and there is no consensus between most specialists. This case series seeks to describe and clarify management's current state and future. Objective: The purpose of this study was to determine the outcome of single staged MLKI reconstruction. Materials and Methods: It is a hospital-based case series conducted on 10 patients. Patients who were surgically treated for MLKI between 2017 and 2020 were included in this study. In our study, we included patients with grade 3 or grade 4 cruciate ligament injury with grade 3 or 4 collaterals injury for arthroscopic reconstruction. Data were collected pre- and postoperatively and their Lysholm and International knee documentation committee (IKDC) scores were used to evaluate the outcomes. Results: A male predominance was noted in the present study. Road traffic accidents were the most common mode of injury (70%). Anterior cruciate ligament and medial collateral ligament combination constituted the most common injury pattern (70%). Overall, there was a statistically significant difference in outcomes postsurgery with regards to pre-operative and postoperative Lysholm and IKDC scores in our patients with a P-value of less than 0.0001, substantiating the need for surgical management of MLKI. With a mean postoperative Lysholm score of 89 and a mean postoperative IKDC score of 85, this study showed functionally good results in the patients treated in a single sitting. At the end of 1 year, none of the patients showed positive results for anterior drawer and valgus or varus stress tests. None of the patients showed extensor lag at the last follow-up. Conclusion: A wide variety of management approaches have been described for MLKI. Proper evaluation and full diagnosis are key in multiligament injury of the knee. Failure to treat all injured structures can lead to changes in knee kinematics, poorer outcomes, and increased risk for graft failure. Single-stage early surgical treatment with proper rehabilitation yields good functional and clinical outcomes with early return to work and sports activity.

A prospective study of functional outcome of posterior tibial spine chip fractures treated with screw fixation

Aim: To study the functional outcome of posterior tibial spine fractures treated with threaded Cannulated cancellous Screw fixation. Materials and Methods: This is a prospective study of Posterior Tibial Spine Avulsion fractures in the age group 15-60 years admitted in Government Medical College, Kota, during the period from August 2020 to December 2022. The cases were classified under Modified Meyers and Mckeever classification. Patients with associated vascular Injury and skeletally immature and age group more than 60 years were excluded. Through Burks and Schaffer approach, avulsion fractures of Posterior Tibial Spine were fixed with 4mm partially threaded Cannulated cancellous Screw. Discussion: In our study, the mean age group of the patient was 33 years with a male preponderance. Road traffic accidents and accidental fall were the commonest mode of injury and the mean operating time was 43.5 minutes. Post operatively the knee flexion was around 120 degrees in average. And 15 patients had excellent outcome with Lysholm knee scoring scale and 5 had good outcome with no patients with fair or poor outcome. Results: Open reduction and internal fixation of Posterior Tibial Spine avulsion fractures through Burks and Schaffer approach had yielded excellent results in our study. A displaced avulsion fracture of Posterior Cruciate Ligament with more than 10 mm posterior tibial translation should be reduced and fixed in order to stabilise the joint and to prevent non-union.

Functional Outcome of Isolated Middle to Distal Third Ulnar Shaft Fracture in Adults with Square Nail Fixation

Introduction: Isolated ulnar shaft are uncommon injuries with most of the fractures occurring following direct trauma. Open reduction and internal fixation with plating is the gold standard treatment but is associated with complications. Treatment with square nail provides rotational stability, is cheaper, safer with minimum complications of plating.&#x0D; Aims: To evaluate the functional outcome of isolated fracture of middle third to distal third ulna treated with square nail.&#x0D; Methods: This prospective observational study was conducted in the Department of Orthopedics at Nepalgunj Medical College Teaching Hospital Kohalpur from September 2018 to August 2022. Patients aged above 18 and below 60 years who had displaced isolated fracture of middle third or distal third of ulna were evaluated for demographic details, union, functional outcome and associated complications. All of the fractures of ulna were treated by square nail and outcomes were evaluated using disability of arm, shoulder and hand (DASH) score and Grace and Eversmann scoring system.&#x0D; Results: In this study of 39 patients with the mean age of 30.84±8.12 years, 56.4% of the patients were in age group 18-30 years, 27 (69.2%) were males and 12 (30.8%) were females. The right limb was fractured in majority, distal third was more commonly involved, physical assault was the most common mode of injury, transverse was the most common fracture pattern. The average time to union was 11.61±2.74 weeks. Most (74.4%) of the patients had good result in DASH score and most (94.9%) had good to excellent result in Grace and Eversmannscoring at final follow-up. The most common complication noted was olecranon bursitis (17.94%) followed by skin irritation (12.82%).&#x0D; Conclusion: Square nail fixation of isolated middle third to distal third ulna is safe procedure with few complications, produces excellent to good results.

Demography and Outcome of Pediatric Traumatic Brain Injury; Experience from a University Teaching Hospital in Nepal

Introduction: Traumatic brain injury (TBI) is one of the significant causes of disability and death. It is a common cause of emergency neurosurgical consultation. Due to differences in physiology and management strategy, outcomes of pediatric TBI are different. This study purposes to describe the demography, clinical-radiological characteristics, and outcome of patients with pediatric TBI. Methods: A retrospective study of 112 children of age up to 18 years admitted to the Neurosurgical Department in Tribhuvan University Teaching Hospital following TBI from August 2021 to July 2022 was conducted. Variables analyzed were the demographics, clinical characteristics, imaging findings, management strategies, and outcome. Results: Median age was 5.5 years. The male-to-female ratio was 2.3:1. Falls followed by road accidents (RTA) were the most common mode of injury. A significant number of patients (62, 55.3%) presented after 24 hours of injury. Vomiting (67, 59.8%) was the commonest symptom followed by loss of consciousness (60, 53.6%). Post-traumatic seizure was observed in 13 (11.6%) of the children; however, had no association with the outcome. Mild, moderate, and severe TBI were seen in 80.3%, 17.8%, and 1.7% respectively. Extra-axial hematomas (40%) were the most common findings followed by skull fractures (33.9%). Intensive care was required in 13 (11.6%) and 34 (30%) required surgery. Craniotomy (30.3%) was the most common procedure. Good outcome at discharge was seen in 107 (95.5%) of patients. Conclusion: Falls and RTAs were the commonest causes of pediatric TBI. In our study, a significant number of the patients presented after 24 hours of injury. Craniotomy was the most common managment and most of the children had good outcomes at discharge.

A Decade of Imaging Patients with Traumatic Brachial Plexopathy: What have We Learned?

Aim In this paper, the authors share their experience of imaging patients with traumatic brachial plexopathy by magnetic resonance neurography (MRN) spanning over a period of nearly 10 years. Setting and Design This was a single-institution, prospective, observational study conducted between August 2012 and March 2022. Materials and Methods Children and adults presenting to the plastic surgery outpatient department with features of traumatic brachial plexopathy were included in the study. The MRN study was performed in a 1.5T scanner (Magnetom Essenza, Siemens, Erlangen, Germany). The area scanned extended from C3 level to T3 level. Statistical Analysis Descriptive statistics (percentages, mean, median, and mode). Results A total of 134 patients ( n = 134) were included in the study. The age of our patients ranged from 6 months to 65 years. The mean age was 24.95 ± 12.10 years, with a median of 23 years. All patients had unilateral injury, and the right side was more commonly involved. Road traffic accident was the most common mode of injury, and blunt crush-avulsion was the most common mechanism of injury. Involvement of shoulder, elbow, and hand together (panplexopathy) was the most common clinical presentation. Conclusion This study of patients with traumatic brachial plexopathy imaged by MRN, spanning nearly a decade, has led to several interesting observations. The majority of these injuries occur in young men from urban areas who usually present with panplexopathy. The most common mode of injury is road traffic accident, and blunt crush-avulsion is the most common mechanism of injury.

To Describe Clinical Profile and Meticulous Documentation in Ocular Medico-Legal Cases at Tertiary Hospital in Ahmedabad

Background:Ophthalmologists play an important role in the management and fixing of legal responsibility in ocular medico legal cases (MLCs). All penetrating or non-penetrating intentional ocular trauma causing loss of an organ or part of organ and which have as consequence the facial disfigurement or post trauma complication have forensic implications.Objective:To describe the clinical profile and meticulous documentation in ocular medico-legal cases attending the ophthalmic unit at a tertiary care hospital in Ahmedabad.Methods:Medical records of ocular MLC from May 2018 to November 2020 were considered. A total of 112 cases of ocular injury constituted the sample size. The injuries were categorized as adnexal and globe injuries. The clinical profile was recorded in the clinical record forms and analyzed accordingly. Results: A total of 112 patients with ocular trauma were recruited with follow up to 6 months following recruitment. The most affected age group was 26-40 years (25.89%). The most common mode of injury was assault with fist in 22 (18.74) of cases. Most patients had open globe injury (28, 25%), while 20 (16.5%) had closed globe injury, 38 (33.93%) had the adnexal injury, 7 (6.25%) had open plus adnexal, 7 (6.25%) had closed plus adnexal and 12 (10.71%) had chemical injury. Adnexal injuries were the most common (38,33.93%). Lid / periorbital contusion and sub-conjunctival hemorrhage were the most common presentations among adnexal and globe injuries respectively. Malingering was present in 3(3 %) cases. Furthermore, among the adult population, majority 28 (25%) had ocular injury at workplace, while most pediatrics injuries 23(20.54%) occurred at home during play. Incidence of monocular blindness was 2(9%) at 6 months follow up. Factor that was associated with monocular blindness was open globe injuries. Conclusion: Fist injury was the most common cause of trauma to the eye. A substantial number of patients who had adnexal injuries or sub-conjunctival hemorrhage had good vision, contrary to open globe injuries which resulted in very poor vision. Keywords:Forensic medicine, Medico-legal case, ophthalmic MLC, ocular trauma

To Study the Arthroscopic Management of Meniscal Injury of Knee Joint and its Functional Outcome at a Rural Care Centre

Background: Meniscal tears are the most common injury of the knee, with an incidence of meniscal injury resulting in meniscectomy of 66 per 100,000 populations per year. Menisci are essential for the normal function of the knee joint. In the modern diagnosis of meniscal injury and planning of the appropriate intervention, a good patient history and clinical examination have been supplemented with precise non-invasive imaging. Conservative approach has moved, with the correct indication, towards surgical treatment. Interestingly, the very first treatment for meniscal lesions was repair and not resection, suggesting that keeping the meniscus in place was the right approach all along. Aim and Objective: To study the Arthroscopic Management of Meniscal Injury of Knee Joint and its Functional Outcome Material and Methods: A prospective study was carried out among patients with meniscal injuries of knee joint and getting admitted under orthopaedic department at rural care center. All patients having meniscal injuries having age between 20 to 60 years, getting confirmed of meniscal injury on MRI and willing to participate were considered for the study. Thus such 50 cases were studied and evaluated. Patients with infection in and around the knee joint were excluded from the study. Data analysis was done using Software Open Epi version 2.3.1. Results: Mean age in years was 42.8+4.6. Majority 60% were females. Common mode of injury was road traffic accident (75%). Medial meniscus was commonly involved (80%). 48% cases showed good functional outcome, 32% showed excellent and 10% showed fair outcome. Complications were seen among 13% cases. Conclusion: The need to accurately evaluate the knee injuries is very crucial for the proper management and outcome; otherwise it will lead to chronic debility to the patient. Arthroscopy can accurately detect, localize and characterize various internal derangements of the knee joint and help in arriving at a correct anatomical diagnosis ...

Traumatic brain injury in pediatric patients –Clinical manifestations and outcome

Background: Pediatric traumatic brain injury (TBI) is a global public health concern and is preventable, but there are no approved therapies to treat it definitely until date. Falls are the most frequent mode of injuries followed by road traffic accidents (RTA). Most of the TBIs have favorable outcome, though this is influenced by geographical, environmental, societal, and ethnic differences. Aims and Objectives: The aims of this study were to determine the several modes of injury, severity of injury, outcomes, and complications in the Eastern Indian population. Materials and Methods: Children-aged &lt;18 years suffering from TBI who were attended to in Bangur Institute of Neurosciences, Institute of Post-Graduate Medical Education and Research, Kolkata, were prospectively studied for 1 year. Detailed history, clinical examinations, assessment of pupillary status, and Glasgow Coma Scale (GCS) score was recorded. Severity of TBI was done based on GCS score for each case. Computed tomography (CT) scan of head without contrast was the initial mode of neuro imaging and findings were recorded diligently. Patients were treated conservatively and surgically as required. Outcome was assessed in relation to age group, gender, initial GCS score, pupillary status, CT findings, intervention, and associated injuries. Simple statistical analysis was done. Results: Among the total 150 patients aged 1–18 years, most common mode of injury was fall in 56.66% followed by RTA in 23.33%, assault in 6.66%, and other modes such as sports, hit by object on head, and firearm injury in 13.33%. RTAs had a poor outcome in 14.29% and fall had a poor outcome in 14.12%. Poor outcome was associated with the highest (68%) being midline shift (MLS)&gt;3 mm and it was 12.77% with MLS of &lt;3 mm and it was 10.26% in patients with no MLS. It was noticed that chest, spinal, and multiple injuries were associated with poor outcome. Conclusion: The most important prognostic factors regarding pediatric TBI are GCS at presentation, pupillary status, associated injuries, and CT scan findings.

Study on Head and Neck Tumours Presented in OPD of Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh

Introduction: Head and neck trauma includes many facial fractures as well as soft tissue injury to face, oropharyngeal injury and also trauma to neck. Head and neck trauma may or may not be associated with fractures like maxillofacial fractures or isolated fracture of nasal bone. Objective: To find out study on Head and Neck tumours presented in OPD of Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh. Material and Methods: This retrospective study was done in the Department of ENT &amp; Head-Neck Surgery, Shaheed Ziaur Rahman Medical College Hospital, Bogura, Bangladesh from July to December 2021. Total 51 inpatients with a diagnosis suggestive of head and neck trauma Data was collected for age, sex, address, type of admission (Emergency/OPD), mechanism of injury, site of injury, imaging including X-rays/CT scan wherever applicable and results, surgical therapy, type of anesthesia, hospital admission duration, complications, and follow-up and analyzed. Results: Of the 51 cases, most of them were adult age group 62.7%, the females were 37.3% (19) and 62.7% (32) were male. In our study patients were divided into three age groups; pediatric (0-14 years), adult (15-60 years) and geriatric (&gt;60years). Most of the patients belonged to the adult age group. 13.7% had presented to emergency room (ER) and 86.3% presented to outpatient department (OPD). Fall was the most common mode of injury (100%) in both pediatric and elderly population and in adults RTA (42.10%) was the most common mode. In the type of injury most common in pediatrics was oral cavity and oropharyngeal injury (47.60%), in adult’s facial soft tissue injury (STI) and facial fractures (42.10%) were equally common and in geriatrics it was (100%). Concision: Adult males were prone to head and neck trauma mostly sustaining soft tissue injury (STI) and fractures due to RTA and physical assult. Injury to oral cavity and oropharynx and STI due to fall is common in extreme of ages. .......

INJURIES IN THE NATIONAL CAPITAL REGION – A CROSS-SECTIONAL STUDY OF THE CHALLENGING EPIDEMIC.

Background: Injuries are an emerging public health problem that has grown into epidemic proportions. Many injuries are linked to social, environmental, cultural, and biological issues in causation; recognized as man-made and behaviour-linked disorders, and linked to sociodemographic transition. Prevention, acute care, and rehabilitation are the major challenges we are facing today. Materials &amp; Methods: A crosssectional study was conducted at the National Injury Surveillance Centre (NISC) Department of Dr. Ram Manohar Lohia Hospital, New Delhi. Data was collected from 2861 participants (&gt;18 years) of injury cases during 12 months (Jan-Dec 2019). Participants were selected using the Convenience Sampling Technique. The data were analysed statistically using SPSS software to assess the risk factors and pattern of injury among the population of the National Capital Region, Delhi. Results: In this study, the mean age was 36.6 years. The male to female ratio was 2.1:0.7. The age group 18-45 years is affected predominantly (71.1%). Around 48.8% were students (matriculation/junior school). 39.5% (1131) were unemployed. 1999 (69.9%) were accidental (unintentional), 1671 (58.4%) were having moderate to severe injury, 1675 (58.5%) happened onroad, and 1341 (46.9%) were having soft tissue injury. 1198 (41.9%) were RTI cases and 816 (28.5%) were assault/quarrel cases, the second most common mode of injury. Conclusion: With the realization that injuries are caused by a complex interaction among agents (vehicle, product), and human and environmental factors operating in complex social and economic systems, injury prevention and control depending on evidence-based research is gaining momentum. There is an urgent need for developing comprehensive, integrated, and intersectoral approaches based on scientic understanding.

Surgical outcomes of canalicular tear repair with self-retaining Mini-Monoka stent in a tertiary care hospital in Kashmir in North India

Background: Canalicular lacerations contribute to approximately 16% of the eye lid injuries. The torn medial end is to be identified, cut end sutured, and then the canaliculus intubated to restore patency. Silicone being inert, flexible, easily available, and cost effective is the material of choice for lacrimal stenting. Aims and Objectives: The aim of this study was to determine the surgical outcomes of the canalicular tear repair with the self-retaining Mini-Monoka stent in a tertiary care hospital in North India. Materials and Methods: Patients presenting to tertiary care hospital in Kashmir, North India with canalicular tear from August 2019 to December 2020 were included in this prospective study and repaired with self-retaining Mini-Monoka stent under microscope. All the patients were analyzed for demographic data, mode of injury, complications, and outcomes and followed up after a week, 6 weeks, and 3 months and stent removed after 6 weeks. Results: The study was conducted on 18 patients. The mean age of the patients was 37.5 years with male: female ratio of 5:1. The lower canaliculus was most commonly involved and road traffic accidents was the most common mode of injury (27.7%). The most common associated injury was lid injury (50%). The mean time of stent removal was 6 weeks±2 weeks. Syringing was done in all the patients except children. At last follow-up, 17 out of 18 patients had functional and anatomical success in terms of absence of epiphora and patent syringing and all the patients were cosmetically satisfied. Conclusion: Our study concludes that surgical repair of canalicular tear with Mini-Monoka stent is a safe and simple reliable technique, cosmetically satisfying with minimal manipulation giving high functional and anatomical success rate post repair.

Prospective study of surgical management of anterior cruciate ligament injury using bone patellar tendon bone graft

Background: Anterior knee instability associated with rupture of anterior cruciate ligament (ACL) is a disabling clinical problem in general and especially in athletic individuals. ACL has a poor capacity of healing. The need for surgical correction of ACL injuries arises because, untreated complete injury to the ligament leads to progressive symptomatic instability leading to recurrent injury and damage to the menisci and articular cartilage thus resulting in early osteoarthritis. The bone-patellar tendon-bone auto graft has been widely accepted as the gold standard for ACL reconstruction with a high success rate. Aim: To study the functional outcome of ACL reconstruction using BPTB graft, various advantages and complications following ACL reconstruction using BPTB graft.Methods: The present study was carried out at Department of orthopaedics, Navodaya Medical College and Hospital, Raichur. It is a Descriptive observational study. All patients (30) with diagnosis of ACL tear are included during the period of September 2017 to August 2019.Results: Majority of the patients i.e. 12 (40%) were from 15-25 years age group Male predominance was found in our study. 24 (80%) patients were males and 1 (20%) patient were females. Male to female ratio was 4:1.Right knee involvement was seen in 18 patients i.e. 60% and left sided knee involvement was seen in 12 (40%). In majority of the patients i.e 15 (50%), sports was the commonest mode of injury. Knee pain was commonest symptom in 15 i.e. 50% patients. Instability was complained by 9 (30%), knee pain with instability by 4 (13.3%) and locking by 2 (6.7%). Mean score at 3 months was 80.2±12.3. At 6 months was 85.3±9.2. At 1 year was 91.1±8.7. At 18 months was 94.2±8.1 and at 2 years it was 95.8±7.1. When we compared the mean XIV score at different follow up periods, it was found to be statistically significant (p

REVIEWING THE ROLE OF INTRAVENOUS STEROIDS IN BLUNT CHEST TRAUMA-LUNG CONTUSION

Objective: The aim of the study was to see the effect of intravenous steroids in patients with blunt chest trauma-lung contusion and to compare the effect of steroid use based on improvement in oxygen saturation, ABG, and hospital stay, in the study group and control group. Methods: A prospective and observational study was carried out on patients with blunt chest trauma having lung contusion who were admitted to the multispecialty hospital for 2 years. Data were collected in a predesigned proforma. All patients with radiologically proven lung contusion were observed based on the steroid treatment given or not. Group A was steroid (study) group and Group B was non-steroid (control) group with 25 sample size in each group. Group A patients were treated with steroid (hydrocortisone) 20 mg/kg/day 6 hourly which was tapered over time. Control group patients were treated identically except for steroid use. Results: Most of the injuries affected the middle age group (25 to 65 years) which accounted for a total of 84%. The percentage of males and females in the study were 76% and 24%, respectively. The most common mode of injury was road traffic accidents which account for 76% as compared to non-road traffic accidents (24%). Statistical analysis showed there was an improvement in both groups in parameters such as Spo2, ABG-Pco2, and ABG-Sao2 and were statistically significant. While other improvements like ABG-Po2, radiological CT, and hospital stays were statistically insignificant. Conclusions: As both groups were showing improvements and there was no statistically much difference seen in both groups, we concluded that there is no role of intra-venous steroid use in lung contusion. However, every patient must undergo CT for a better assessment of the injury. Objective scoring systems are required in CT assessment of lung injury and studies with increased sample size and carried out at multiple centers are required for better conclusions.

Management of Unstable Per-trochanteric Fracture in Old Patient by Primary Prosthetic Replacement

Background: Peritrochanteric fractures are frequent of the proximal femur and represents about half of all proximal femur fractures. They are associated with disability, mainly in elder patients. Its management aiming to achieve immediate ambulation and to regain the pre-operative ambulation.&#x0D; Aim and objectives; to evaluate and assess the functional and radiological outcomes of primary prosthetic replacement in old age cases of unstable per-trochanteric femur fractures,&#x0D; Subjects and methods: The current work was an interrupted time series clinical trial (quasi experimental), included 15 patients suffering from unstable per-trochanteric fracture presented to us within a week of sustaining injury. They were clinically assessed and checked for fitness for surgery. Then and after surgery, they were followed by for functional outcome by Harris Hip Scale and any complications were recorded.&#x0D; Results: Patients age ranged between 61 and 94 years. Females were more affected than males (80.0% vs 20.0%). Associated comorbidities were hypertension, diabetes and both conditions among 33.3%, 6.7% and 33.3%, successively. Falling was the commonest mode of injury (60.0%), and the left side was more affected than the right (60.0% vs 40.0%). Associated injuries were 1(6.7%) fracture surgical neck hummers, 1(6.7%) contralateral both bone leg fracture, 1(6.7%) had fracture mid shaft ulna. Regarding outcome, all cases were free from postoperative complications. However, blood loss was reported among 11(73.3%). Twelve (80%) patients had an excellent, 2 (13.3%) had good and 1(6.7%) had fair functional outcome. There was significant association between functional outcome and patients, gender, associated comorbid medical conditions, mode of trauma, side of trauma, or blood loss.&#x0D; Conclusion: Primary prosthetic replacement is a valid surgical option in management of unstable trochanteric fractures in elderly. The main advantages are the safety, effectiveness and early full weight bearing.

Kneeling Stress Radiography: A Forgotten Yet Dependable Tool for Postero-lateral Knee Instability.

Diagnosing postero-lateral knee instability is a challenge from both clinical and radiologic perspective and can lead to significant morbidity if left untreated. Delayed diagnosis leads to a more demanding surgery and prolonged rehabilitation for the patient. Kneeling stress radiograph is a lost art but remains invaluable in the assessment of postero-lateral knee instability. This prospective observational study is aimed at re-exploring the undeniable utility of this forgotten tool in early diagnosis of posterolateral knee instability and identifying the mean posterior tibial translation distance (PTTD) and also assessing side to side difference (SSD) between the injured and the contralateral normal knee. Total 27 patients were included in the study, with males being 4.4 times more commonly injured as compared to females. The most common mode of injury was motor vehicle accident (MVA). Out of 27 patients, 11 had isolated PCL (posterior cruciate ligament) injury while the rest had PLC (posterolateral corner) involvement. The mean SSD of PTTD was 8.79mm in patient with isolated PCL. This was increased by 1.65 times (14.52mm) in patients with co-existing PLC involvement. Stress radiography is an indelible tool and serves as an adjunct to MRI imaging. It is not a substitute for clinical assessment but assists in early diagnosis and management, facilitating surgical planning and furnishing objective evidence of PCL/PLC functionality which is not possible with any other imaging modality.