DASH Scoring System Research Articles

Management of adhesive capsulitis of shoulder joint with arthroscopic release vs. manipulation under anaesthesia: a comparative study

Background: Shoulder stiffness is a manifestation of various pathologies or clinical scenarios variously described as scapula humeral periarthritis, frozen shoulder and adhesive capsulitis. Frozen shoulder is characterized by significant restriction of active and passive motion of the shoulder that occurs due to unknown factors. Adhesive capsulitis causes contracted, thickened joint capsule that seemed to be drawn tightly around the humeral head with a relative absence of synovial fluid and chronic inflammatory changes within the subsynovial layer of the capsule. In this study we did a comparison of 30 patients treated with arthroscopic release and manipulation under anesthesia. Methods: There were 30 patients in this study with 15 patients in each group of different age groups. All the patients were studied for a period of one year between July 2021 to July 2022. The functional outcomes were assessed using dash scoring system. Results: in this study of 30 patients with different age groups followed for 12 months and assessed by DASH scoring system. We had excellent results in arthroscopic group with postop dash score standard deviation is 5.87. Conclusions: The arthroscopic capsular release of shoulder joint in adhesive capsulitis was found to have a better functional outcome as compared to the manipulation of shoulder joint under anaesthesia. Currently no treatment protocols are universally effective which needs more and more research and developments for proper treatment strategies. Morbidity with this condition has caused significant loss both economically and psychologically.

A PROSPECTIVE STUDY TO ASSESSTHE FUNCTIONAL OUTCOMES OFDIAPHYSEAL BOTH BONE FRACTURESOF THE FOREARM IN ADULTS TREATEDBY OPEN REDUCTION AND INTERNALFIXATION WITH DYANAMICCOMPRESSION PLATE

Indroduction: Forearm fractures can be regarded as articular fractures as slight deviations in the spatial orientation of the radius and ulna will significantly decrease the forearmÂ’s rotational amplitude and thereby impair the positioning and function of the hand. Thus, the management of these fractures deserve special attention as their treatment is not the same as the treatment of other diaphyseal fractures.Open reduction and internal fixation for diaphyseal fracture in the adults are generally accepted as the best method of treatment, even though closed reduction may be achieved. Objective: The Objective of this study is to evaluate the functional outcome after open reduction and internal fixation of the forearm diaphyseal fractures by Dynamic Compression Plate (DCP). Methods: This is a prospective study of 72 cases of diaphyseal both bone forearm fractures in adults who attended casualty and of Government Medical College Hospital, Kozikkode and were treated by open reduction and internal fixation with dynamic compression plating between September 2020 to August 2022. Results: The functional outcome as per DASH scoring system in dynamic compression plating (DCP) group was that 85 % (61 patients) had excellent results, 15 % (11 patients) had good results with no patient having fair and poor results. Conclusion: Fixation with Dynamic Compression Plate has stood the test of time and provides excellent fixation. DASH is a widely accepted standardized scoring system to assess upper limb function. In comparison with few of the previous studies our results are better in terms of functional outcome.

NON-DRUG NON-INVASIVE TREATMENT IN THE MANAGEMENT OF TENNIS ELBOW

Introduction: Tennis elbow is a common disorder of upper extremity. Majority of the patients can be treated conservatively. It is the major cause of disability and time off work, after low back pain. The disease impacts upon activities of daily living ultimately leading to a loss of functional independence and quality of life. Purpose: The main purpose of this study was to assess the results of nondrug non-invasive treatment in the management of tennis elbow. This study was conducted in the department Methods: of Orthopaedics from December 2010 to December 2015. One hundred ten outpatients of tennis elbow with a mean age of 45 years were studied. They were managed with non-invasive treatment and were followed for twelve months. At twelve months follow-up visits, the intensity Results: of tennis elbow pain and disability were assessed by using Quick dash scoring system and Patient-rated elbow evaluation system. Physician global evaluations up to the age of 40 years at twelve months were excellent. At 40 to 60 years of age, it was good to excellent. Over the age of 60 years, it was good. The patient global evaluation was found very good up to the age of 40 years at twelve months follow up, good to very good between 40 to 60 years and over the age of 60 years it was good. Nondrug non-invasive interve Conclusions: ntions can reduce pain and improve function in tennis elbow.

A comparative study of functional outcome of intraarticular distal radius fractures treated with K wire versus conservative management

Background: Intraarticular distal radius fractures are commonly seen fractures of the upper extremity showing bimodal distribution in pediatric and elderly adults. The age distribution of distal radius fracture is typically peaks in the 5-14 year age group and also peaks in elderly patients more than 60 years of age. Aim: To compare the functional outcome of intraarticular distal radius fractures treated with k wire versus conservative management. Material and methodology: The study was conducted between July 2020 to December 2021 in the department of orthopaedics, RMMCH, 20 patients with intraarticular fractures of the distal radius were included in the study. 10 patients were treated with k wire/ligamentotaxis with k wire, 10 patients were treated with conservative methods. Follow up was done for a minimum period of 6 months, functional outcome was assessed using the Quick DASH Scoring system. Results: The functional outcome in the k wire group was 12.9, which was found to be better than the conservative group 17.49. No poor outcome was seen in the k wire group. 2 patients had a poor outcome in the conservative group. Malunion was found in 2 patients in the conservative group. No patients had malunion in k wire group. Superficial pin site infection was found in one patient. Stiffness was found in 1 patient in the k wire group and 3 patients in the conservative group.Conclusion: In our study, the functional outcome results were better in the patients managed with surgical intervention by percutaneous fixation using K wire/ligamentotaxis with k wire than in patients managed with the conservative method by closed reduction and cast immobilisation.

TO EVALUATE THE FUNCTIONAL OUTCOME OF METACARPAL FRACTURES TREATED BY DIFFERENT TECHNIQUES

Background: Metacarpals fractures are most common. Management varies from conservative to operative techniques.
 Aim: To evaluate the functional outcome of metacarpal fractures treated by different techniques.
 Patients and Methods: a total of 65 fractures in 50 patients managed by various modalities (conservative as well as operative). Functional outcome was assessed by using TAM and DASH scoring system at 6th week, 3rd month and at 6th month.
 Results: 62 fractures united and three fractures mal-united at the time of final assessment. Overall excellent and good results were achieved in 90% cases (45 out of 50 cases).
 Conclusion: Operative technique is better option in case of unstable fracture and conservative technique is better in case of stable fractures. Finally we concluded that the detailed clinical and radiological assessment of fracture and choosing the correct method of treatment are critical in achieving good results.
 Keywords: Metacarpal bones, total active movement (TAM), disability of arm, shoulder and hand score (DASH).

Management of fractures of radius and ulna using dynamic compression plating

Aim and Objective: This study has been taken to determine the functional outcome of treating diaphyseal fractures of both bones, forearm with Dynamic compression plate at Mediciti institute of medical sciences, Ghanpur from October 2018 to March 2020. Methodology: This is a time-bound prospective study. Twenty cases of fractures of both bones forearm was treated by open reduction and internal fixation with 3.5 mm DCP. The follow-up ranged from 5 months to 18 months. Results: Males predominant with right forearm affection more than left. Most of the fractures due to RTA and fall. The average age was 35 years with fracture being most common in third decade. Most of the fractures of both bones forearm were located in the middle third and the fracture pattern transverse/short oblique was commonest. 18 (90%) patients has sound union in less than 6 months, 2 (10%) patients had delayed union. The results were based on Dash scoring system and in our study, there were 18 (90%) patients with excellent results and 2 (10%) with satisfactory and no unsatisfactory results. Conclusion: Hence the study was on par with the previous studies and DCP is proved to be the best mode of treatment for diaphyseal fractures of both bones forearm.

Compare the Outcomes of Mini-Plate versus K-Wire Fixation in Patients with Shaft of Metacarpal Fractures

Objective: To compare the functional outcomes of K-wire versus mini plate fixation for the treatment of fractures shaft of metacarpal. Study Design: Randomized controlled trial Place and Duration of Study: Department of Orthopaedic, Sahara Medical College, Narowal from 1st August 2020 to 31st January 2021. Methodology: Fifty six patients of both genders presented with fractures shaft of metacarpal were included. Patient’s ages were ranging between 15 to 60 years. Radiographic assessment was done to all the patients. Patients were categorized in to two equal groups. 28 patients treated with mini plates (group A) and 28 patients treated with K-wire fixation (group B). Post-operative complications were examined and compare between both groups. DASH scoring system was used for analyzing functional outcomes. Results: Mean age in group A was 34.57±7.84 years and in group B it was 34.95±7.76 years. Majority of patients 18 (64.29%) and 17 (60.71%) were males in group A and B. Mean time of union in group A was 9.58±2.24 weeks while in group B it was 12.33±2.85 weeks, the difference was statistically significant (p-value <0.05). As per DASH criteria, 15 (57.14%), 11 (39.29%) and 2 (7.14%) patients had excellent, good and fair functional outcomes who treated with mini plates internal fixation, while in group B 12 (42.86%), 13 (46.43%), 2 (7.14%) and 1 (3.57%) patients had excellent, good, fair and poor functional outcomes. Postoperative complications were more in group B as compared to group A but the difference was not statistically significant (p-value >0.05). Conclusion: Both procedures mini-plate internal fixation and K-wire fixation are effective for fractures shaft of metacarpal. However, mini-plates showed better functional outcomes with fewer rate of postoperative complications and earlier union as compared to K-wire internal fixation. Keywords: Shaft of metacarpal fracture, Internal fixation, Mini-plate, K-wire, DASH scoring system

Evaluation of functional outcome of diaphyseal fractures of shaft humerus treated with closed interlocking nail in adults

<p class="abstract"><strong>Background:</strong> Humeral shaft fractures are those fractures of the diaphysis of the midshaft that do not involve the proximal or distal articular joints. Humerus fractures have a substantial impact on personal function and well‐being and are one of the causes of excessive mortality among the elderly. The aim and objective of the study was to study the functional assessment after interlocking nailing in fractures of shaft humerus.</p><p class="abstract"><strong>Methods:</strong> A retrospective clinical study was done on 20 patients with shaft humerus fractures treated with intramedullary nailing by orthopaedic surgeons at a tertiary care centre in the Department of Orthopaedics, Indian Institute of Medical Science and Research, Noor hospital, Jalna between January 2020 to July 2020 (DASH Score being calculated till January 2021). The DASH score was assessed 6 months post-operative day of surgery.</p><p class="abstract"><strong>Results: </strong>For all the operated patients clinical, physiological and ortho-radiological assessment were performed to observe and evaluate fracture stabilization, reduction, fracture healing and callus formation, functional evaluation done with DASH scoring system.</p><p class="abstract"><strong>Conclusions:</strong> Closed intramedullary nailing is safe and reliable technique to fix humeral shaft fracture. It provides early fracture consolidation, with high union rate, with advantage of early mobilization of the involved limb.</p><p class="abstract"> </p>

A comparative study of functional outcome of type 2 and 3 radial head fracture treated with radial head excision versus radial head fixation

Background: This study was conducted to compare the results of radial head excision versus radial head open reduction and fixation in Type 2 and Type 3 Mason fracture of radial head using Quick Dash scoring system. This study suggested better Quick Dash score was associated with radial head fixation as compared to radial head excision.Methods: Out of 40 participants who underwent surgery for Type 2 and 3 Mason radial head head fracture, 20 patients had undergone radial head excision and 20 patients had undergone open reduction and internal fixation. Patients were followed up post-operatively upto 6 months and were evaluated on the basis of Quick Dash scoring system.Results: Out of 40 patients, 27 were males and 13 were females. The Mean age group of this study population was 38.8 years with SD of 12.5 years. Even though, the elbow range of motion was comparable between two groups, those who had undergone radial head excision had an average score of 52.5% where bas those who had undergone radial had fixation had an average score of 60%.additionally patients those who had undergone radial head excision had complaints of elbow instability.Conclusion: Mason Type 2 stable, displaced fractures can be treated satisfactorily with radial head excision, but in the presence of ligamentous injury, there are likely chances of elbow instability and patient may require long term use of orthosis whereas unstable, displaced type 2 Mason fracture and Type 3 communited fracture are better treated with open reduction and internal fixation with either k-wires, screws or plates with fewer complications.

A comparative study of type 2 radial head fractures treated by conservative versus operative management

Aims and Objectives 1. To evaluate the clinical and functional outcome in Type 2 Radial head fracture treated with conservative management or operative management. 2. To study the complications, if any with radial head fracture fixation and conservative treatment. Materials and Methods: 50 patients of Type 2 radial head fractures were treated either none operatively or by open reduction and internal fixation. 25 patients underwent conservative treatment and 25 patients underwent open reduction and internal fixation. Patients were divided into study groups by randomisation. Patients were followed up for a period of 6 months following their injury, and overall results were determined by using the Quick Dash scoring system. Institutional ethics committee approval was obtained before proceeding with this study. Results: In our study, no statistically significant differences were found in the study groups in terms of age, sex, side affected or mechanism of injury. Quick Dash scores were not found to vary significantly in either groups at 6 months. One patient in our study had a palsy of the posterior interosseous nerve following surgery. Conclusion: The authors cannot recommend open reduction and internal fixation for type 2 radial head fractures, as conservative management in this study has shown to have equally good results without the possibility of complications of surgery.

To study the clinical outcome in distal humerus fractures with orthogonal plating via the olecranon osteotomy approach

Objective: The aim of our study was to evaluate the clinical outcome of distal humerus fractures treated with orthogonal plating via the olecranon osteotomy approach in the Indian population, at a tertiary care centre in Kolhapur. Method: A prospective study was carried out in a tertiary care center in Kolhapur. A total number of 16 patients with fractures of distal humerus (AO type B and C) were studied between May2019 to August 2020. All were treated with orthogonal plating via the olecranon osteotomy approach. A mean follow up of 6 months was carried out, and evaluation was done with the help of MEPS and DASH scoring system. Result: The mean radiological union time was 14.6 weeks with an arc of flexion of 101.2 degrees. The outcome measured using Mayo Elbow Performance Score (MEPS) and DASH scoring was 89 and 15.4 points respectively at 6 months. Patient satisfaction was 87% at the end of 6 month follow-up.25% patients reported complications like infection (1 patient), delayed wound healing (2 patients) and hardware prominence (1 patient). No cases of infection or peripheral neuropathies were reported in any of the patients. Conclusion: Orthogonal plating via the olecranon osteotomy approach remains a good alternative showing good clinical outcome in the treatment of distal humerus fractures (AO type B and C). It offers a more stable fixation and the olecranon osteotomy approach gives better exposure for surgery.

The comparative and prospective study on efficacy and functional outcome of autologous platelet rich plasma injection vs hydrodissection in adhesive capsulitis of shoulder

<p class="abstract"><strong>Background:</strong> Adhesive capsulitis of should is also called frozen shoulder which describes a chronic, indolent pathological process in which the body forms excessive adhesions across the glenohumeral joint which in turn leads to pain, stiffness, and loss of range of movements which compromises the quality of life. The objective of the study was to evaluate the efficacy and functional outcome of autologous PRP injection and hydrodissection in adhesive capsulitis of shoulder.</p><p class="abstract"><strong>Methods:</strong> After excluding the patients who failed to satisfy the study protocol, the remaining 100 patients are divided equally into two groups namely group A (n=50) who receive autologous PRP injection and group B (n=50) who receive hydrodissection for adhesive capsulitis of shoulder. Both group participants are followed up pre-procedurally and post-procedurally at the end of 1<sup>st</sup>, 6<sup>th</sup> and 12<sup>th</sup> month for pain relief and range of movements. The improvements in pain and range of movements are charted in terms of VAS and DASH scoring system.<strong></strong></p><p class="abstract"><strong>Results:</strong> The statistical analysis were done for 46 patients in group A and 45 patients in group B which showed a statistical improvement in pain and range of movements (p<0.001 for VAS score and p<0.01 for DASH score) in group A who received autologous platelet rich plasma therapy. Autologous PRP therapy improves the functional quality of life with a long term outcome.</p><p class="abstract"><strong>Conclusions:</strong> For adhesive capsulitis of shoulder, autologous PRP therapy remains functionally superior than hydrodissection as autologous PRP is a constructive procedure by rejuvenating the degenerative tissues.</p><p> </p>

Functional Outcome of Distal end Radius Fracture Treated by Ligamentotaxis by External Fixator with or without K Wire Augmentation

Background: One of the most common injuries encountered in orthopedic practice are Distal Radius fractures. This comprises of 8%−15% of all fractures in adults. The reason for comminuted DER fractures is high-energy trauma in young and low-energytrauma in elderly. They present as shear and impacted fractures involving the articular surface of the distal radius with displacement of the fragments. External fixation for distal radius fracture relies on the principle of Ligamentotaxisin which, a distraction force applied to the carpus aligns the fragments by means of intact ligaments. The length and alignment of fracture fragment is guided by pull and counter pull which are otherwise difficult to control. Objective: To study functional outcome of distal end radius fracture treated by ligamentotaxis with evaluation of functional results according to Disabilities of the Arm, Shoulder and Hand (DASH) score system. Material and Methods: We included 30 patients (Male 24 and Female 6) treated for distal end radius fracture during a period from 2015 to 2017. Patients were evaluated clinically by subjective assessment using DASH Scoring system. Result: After functional evaluation of patients according to the scheduled follow up with mean DASH Score of 76.08 at 1st month, 62.92 at 3rd month and 42.60 at 6th month, and was found to be Highly Significant (p<0.001) among all the compared groups. Conclusion: We concluded that external fixation and ligamentotaxis applied to complex distal radius fractures, when added with augmented K-wire fixation can provide direct augmentation of fracture stability and a good wrist function.

TREATMENT OF MEDIAL EPICONDYLITIS WITH LOCAL INJECTION OF PLATELET RICH PLASMA

Introduction:: Medial epicondylitis is commonly referred to as ‘‘golfer’s elbow,’’ and is characterized by pathologic changes to the musculo-tendinous origin at the medial epicondyle. Actually, epicondylitis is not an inflammatory process, but it is a tendinosis that results from tendon microscopic tearing, followed by an incomplete reparative response. Several treatment options are available as non???steroidal anti-inflammatory medications, physiotherapy, extracorporeal shock wave therapy, local steroid injections and more recently local injection of platelet rich plasma (PRP). Surgery reserved for resistant cases when the mentioned modalities fail. Patients and method: This study included 27 patients presented to El???Hadara University Hospital with chronic symptomatic medial epicondylitis for more than 6 months. All cases received single local injection of PRP and followed up for 3 months after injection. Patientsassessment was done using the VAS and DASH scoring system at the initial visit (before injection) and through the follow up period at 2 weeks, 6 weeks and 12 weeks.Results: Local injection of PRP in cases of medial epicondylitis was a successful method of treatment. When the baseline VAS and DASHscores were compared with the scores at 3 months follow-up, the results showed significant improved across time. Conclusion: local PRP injection significantly reduced pain and increased function in patients with chronic medial epicondylitis

Endoprosthetic Reconstruction of distal Humerus following Resection of distal Humeral Giant Cell Tumours in Six Patients in Rural India.

Giant cell tumour is a commonly occurring benign bone tumour in the Indian population. The common sites of involvement in descending order of frequency are distal femur, proximal tibia, distal radius and proximal humerus. The less commonly occurring sites are distal humerus, pelvis and proximal femur. We present six cases of giant cell tumour involving the distal humerus in rural India. After obtaining a tissue diagnosis by Trucut biopsy and classifying using Enneking's classification, we proceeded to perform wide resection followed by endoprosthetic reconstruction using custom mega prosthesis. We present here six patients (M: F: 2: 4) who were managed by us between 2008-2014. They presented to us with pain around the elbow and restriction in range of movements. They were each noted radiographically to have a lytic lesion involving the distal humerus with the likely diagnosis of giant cell tumour. Closed biopsy was done in all of them to obtain a definitive diagnosis. All patients underwent wide resection and reconstruction using distal humerus custom prosthesis. All patients were followed up at 6, 12, 18 and 24 weeks and thereafter six monthly until the last review. They were assessed using the DASH scoring system. All patients were well with no evidence of recurrence with good to fair functional outcome. We conclude that careful pre-operative planning with meticulous soft tissue dissection and good implant metallurgy and design, these tumours can be treated with good long term functional results.

Prospective study of middle 1/3rd clavicle fracture managed with clavicle contoured plates

Aim Clavicle being most common bone to get fractured, accounting for about 5-10% of all injuries, with middle 3rd being the commonly fractured site. As it is common in young active adults and the incidence being increased due to RTA’s and sports injuries, clavicular plate fixation gained importance in recent trends. Earlier clavicle fracture is managed conservatively with figure of ‘8’ bandage, arm sling or clavicular brace with a relatively good outcome. Though uncommon, nonunion rate of 0.8-1% is seen in conservatively managed patients according to Rowe 1. In 2006 Michael Mckee et al. 2 concluded residual deficits in shoulder strength and endurance in conservatively managed patients. Purpose of this paper is to study clavicle middle 1/3rd fractures treated with plating technique. Materials and Methods Prospective analysis of 30 patients who were operated at MIMS hospital, Nellimarla, Vizianagaram, between Nov 2015 to Jan 2017 for clavicle fractures treated with clavicle contoured plate fixation. Patient position is beach –chair semi sitting position on regular operating table. An oblique skin incision centered over fracture site. Sub cutaneous tissue & platysma muscle are kept together as one layer and extensively mobilized. Supra clavicular nerve is protected. Myofascial layer over clavicle is incised & elevated in one layer. The main fragments cleaned and debris removed. Do not violate the subclavicular space. Then precontoured plate positioned and fixed over superior surface of clavicle and neutral mode for comminuted and unstable fractures. The wound is closed in layers with interrupted, non-absorbable sutures. Review done post- operatively at 2 weeks, 6 weeks, 12 weeks and 6 months. ResultsThe average hospital stay is 7days. 27 out of 30 had functional & radiological union by 12 weeks (range of 6-18 weeks), 2 had deep infection and nonunion, 1 got superficial infection which was treated with antibiotics. No significant difference in functional & ROM scores at 3, 6 months. We followed standard score like Constant Murley score, oxford shoulder score, DASH scoring system for evaluating the functional outcome. We had Average oxford shoulder score of 42 (range 34-48). Lane Sandhu score showed no difference between control group and experiment group, Average Quick DASH score of 46 (range 38-54).ConclusionOpen reduction and internal fixation with clavicle contoured plate is gold standard treatment for displaced middle 1/3rd clavicle fracture. It helps in getting back to daily activities and early mobilization with significantly less nonunion rates.

Clinical Outcome of Treatment of Diaphyseal Fractures of Humerus Treated by Titanium Elastic Nails in Adult Age Group.

Humerus shaft fracture is one of the most common injuries to the musculoskeletal system, which are managed both conservatively and surgically. There are pitfalls, advantages and disadvantages in each method. The individual fracture analysis determines the therapeutic options. To assess the clinical outcome of treatment of diaphyseal fractures of humerus treated by Titanium elastic nail in adult age group by DASH scoring. It was a prospective study of 20 cases of diaphyseal fracture of humerus admitted to Era's Lucknow Medical College and Hospital between October 2014 and September 2015 treated with close reduction and internal fixation with titanium elastic nail. Functional outcome was evaluated using DASH scoring system and radiological outcome was evaluated by serial radiographs. The data was processed with SPSS software version 16.0 (Chicago, inc. USA) and it was summarized in proportion and percentage. In our series of 20 patients, 17 were males and three were females. Most of the patients were between 30-50 years of age (mean 38 years). Most common mode of injury, side of involvement, level of fracture and fracture type were road traffic accidents (60%), right side (53.3%) and mid one third (75%), transverse (60%) respectively. So, in 65% of the patients, there was no disability of arm shoulder and hand as DASH score was within normal range and in 15% of the patients the disability was mild to moderate as scoring was slightly higher than normal and in 20% the disability was severe as the DASH score could not be calculated because of non union. Elastic nail fixation require very minimal soft tissue dissection and being a close reduction, the biology of the fracture is also not disturbed and the chances of nerve injury are much less and as the non union was seen in oblique and spiral fracture type hence it should be used with caution or else other alternative methods of fixation should be used.

A prospective study to analyze the outcome of proximal humerus fracture managed with proximal humerus locking plate

<p><strong>Background:</strong> The incidence of proximal humerus fractures has increased in last few years due to changes in life style and increase in road traffic accidents. Hence, the challenge of the modern day treatment was to get accurate reductions anatomically, fast healing and early restoration of function. Proximal humerus locking plate revolutionized the treatment without compromising fracture union. The present study aimed to evaluate the functional and radiological outcome of proximal humerus fracture managed with proximal humerus locking plate.</p><p><strong>Methods:</strong> This prospective study was conducted at Narayana Medical College Hospital for a period of two years from December 2014 to June 2016. 30 cases of proximal humerus fractures in adults after meeting inclusion criteria were participated and treated surgically with proximal humerus locking plate technique. Consent form was taken from all the patients. The final functional outcome was assessed by radiography and DASH scoring system.</p><p><strong>Results:</strong> Proximal humerus fractures were found to have high incidence in the 40 to 45 age group which had 37% of the study population. Males predominated over females in our study. Ratio of males to female was 2:1. Right sided fractures are more in the present study in both the sexes. The most common mechanism of injury was fall on the outstretched hand from a standing height or less with minor trauma seen in 34% of patients. High energy trauma was more frequently involved in younger patients (30%). According to Neer’s classification two part fractures constituted the most common type 16 (54%) in this study. The collected data was analyzed using SPSS software version 23.0. A ‘p’ value less than 0.05 was considered significant.</p><strong>Conclusions:</strong> The proximal humerus locking plate method for proximal humerus fracture emerges to be safe, effective, reliable fixation with minimal complications.

PROSPECTIVE RANDOMIZED CLINICAL STUDY FOR THE TREATMENT OF LATERAL EPICONDYLITIS; COMPARISON AMONG PRP (PLATELET-RICH PLASM), PROLOTHERAPY, PHYSIOTHERAPY AND ESWT

As recent knowledge proved that pathology of lateral epicondylitis is no more an inflammatory condition, but angiofibroblastic degeneration, steroid injection is no more recommended for lateral epicondylitis. It seems to...

The application of feedback debriefing in simulation-based clinical training

Objective To evaluate the educational effectiveness of feedback debriefing in clinical training. Methods Forty medical students and fifteen teachers were enrolled in the 2015 after-internship clinical training, which was newly designed to obtain the debriefing part. The test scores and single technical practices were collected and analyzed, before and after the training. DASH scoring system was used to evaluate the effect of debriefing in the team simulation. Results were statistically analyzed by SAS 9.2(SAS institute Inc). Quantitative data were described by ±s, while qualitative data were described by number and /or constituent ratio. Student's t test and Wilcoxon rank sum test were applied as needed. A P-value < 0.05 was considered to be significant. Results The scores of the students before and after the assessment were(41.88±8.54) vs. (65.06±13.83), and the difference was statistically significant(P=0.000). Individual skills before and after the course had a different degree of improvement. The average DASH-scores evaluated by the students, teachers and supervisors were (39.3±2.12) (very good), (35.1±4.18) (good) and (37.2±3.03) (very good), separately. Conclusions Potent debriefing helps to improve the effectiveness of simulation-based clinical training. Key words: Debriefing; Feedback; Clinical training; Simulation-based medical education