Orthopaedic OPD Research Articles

Synovial chondromatosis of the shoulder: A rare case report

Synovial chondromatosis is a monarticular svnovial proliferative disease in which cartilaginous or osteocartilaginous metaplasia occurs within the synovial membrane of joints, bursae or tendon sheaths. The disease has been classified into three phases. 1: Early: with svnovial chondrometaplasia but no loose bodies; 2: Transitional: with active svynovial disease and loose bodies; 3: Late: With loose bodies but no synovial disease.Cartilaginous metaplasia from joint, tendo, or bursal synovial lining differentiates this entity from loose bodies arising from degenerative arthritis, osteochondritis dissecans. and osteochondral fractures. A 54 Year Hindu male presented to the orthopaedic OPD with complains of pain and swelling in left shoulder which was insidous in onset, gradually progressive in nature and not relieved by medications. Patient also complained of clicking noise during shoulder movements which was insidous in onset and gradually progressive in nature. Synovial chondromatosis is a synovial lesion seen generally in adults with a male predominance. It occurs most commonly in the knee, unsually also occuring at the hand, wrist, elbow and shoulder. It can lead to mechanical symptoms, decreased range of motion and effusion. Histopath shows nodules of moderately cellular hyaline cartilage. D/D can include Myositis Ossificans, Synovial Chondrosarcoma and Synoval Sarcoma. Treatment is usually observation if asymptomatic. It symptomatic, then arthroscopic or open synovectomy can be done, arthroscopy increases chances of recurrence.

Efficacy of McKenzie, Maitland Mobilisation and Myofascial Release in Chronic Low Back Pain

Objective: To compare the effectiveness of Myofascial Release, Mc Kenzie and Maitland Mobilisation in Chronic Low back Pain and find out the effects of Myofascial Release, Mc Kenzie and Maitland Mobilisation in Chronic Low back Pain. Background: Low back pain is defined as the pain that occurs in an area with boundaries between the lowest rib and the crease of the buttocks. It is one of the most common complain of working-age population. Low back pain is associated with deconditioning of spine and trunk due to lack of core strength and stability in which 60-80% of general population suffer with high recurrence rates of 60 - 85% within following three years. The global prevalence of LBP as 7.3%. Activities that are required for daily living are affected because of LBP. The significance of disability is created because of LBP. The lumbosacral, sacroiliac and lumbar regions are the main regions of LBP. Pain in the back region that lasts for more than three months is called chronic lower back pain (CLBP). Lower?back pain (LBP) is seen in all age groups. Half of the people encounter back pain in a year and nearly three-fourths of the population account for LBP in their lifetimes. It is one of the most disabling factors often preventing sports person for participation in sporting activities. In United States, the workers compensation claims account for about one fourth of all claims and one third of total compensation costs. It results in about 40% of absences from work. In total spinal pain cases low back pain accounts for 60-70%.Chronic Low back pain is the pain that persists longer than the expected time period for healing, with a duration of more than three months. The natural course of most low back pain is of self-limiting in nature, with vast majority of individuals improving within six weeks or less. Study design: Experimental study Methods: 51 subjects were selected through convenient sampling. All the subjects who were diagnosed with chronic low back pain from Orthopaedics OPD was referred to physiotherapy department and was screened and assessed according to inclusion and exclusion criteria. The eligible subjects were approached with proposal of the study. Aim and procedure of the study was explained to the subject and a written informed consent was taken from them in their preferred language. At first the demographic data (age, sex, duration) was collected forever subject. Then the baseline data (pre intervention) of CLP intensity, functional disability was taken before commencement of the study. Then the subjects were randomly allocated each 17 subjects. A final data of pain intensity, functional disability was recorded. Results: For all the outcome measures, no significant difference results were found for all three techniques. Whereas, Mc Kenzie techniques is the most effective and the least effective is Maitland Mobilisation. Mean Improvement calculated as Pre- post values of VAS and RMQ scores at follow-up on 7th and 14th day was compared between the 3 techniques. Its significance was tested by testing whether the 95% CI of the mean improvement included 0 or not. Mckenzie techniques howed maximum improvement 4.68 (2.29, 7.07) on Day 7th and Maitland mobilisation the least improvement, 1.56(0.95, 2.93). Improvement by all techniques was significant at 95% CI using paired t test. However, on day 14th McKenzie showed maximum improvement 5.56(2.72, 7.07)) Maitland mobilization remaining the least effective. Conclusion: LBP is a common condition and all age groups are facing it. Pain can be due to various causes and the line of treatment depends upon the cause of pain. In this review, we found out that LBP is a condition everyone is facing. Mc Kenzie is a better treatment approach over other two techniques to reduce chronic LBP. Pain and disability were the points considered while concluding. LBP affects the quality of life and to maintain or improve the quality of life strengthening the muscles plays an important role. This review gives a brief about the treatment methods available for treating CLBP clinically. Hence physiotherapy treating subjects with chronic low back pain may choose any one technique but Mc Kenzie Technique is the most effective technique for pain and for functional disability in CLBPis the most effective. However sufficient experience and expertise is necessary. Key words: Chronic Low Back Pain, Mc Kenzie, Maitland Mobilisation, Myofascial Release, VAS, RMQ

Incidental Finding of Deranged Renal Function in Elderly Patients Presenting with Fractures in a Tertiary Care Hospital

Objective: To determine the incidental rate of renal impairment among elderly women with fractures who reported to the Orthopaedic OPD at a tertiary care Hospital. Methodology: This prospective cohort study was done at Orthopaedic department and OPD Fauji Foundation Hospital, Rawalpindi during a period of one year from March 2022 to February 2023. A total of 147 females aged >60 years presented with Hip fractures, surgically managed and who had history of normal pre-fracture renal function were included. A 5ml blood sample was obtained and sent to the Hospital diagnostic laboratory to evaluate the renal profile, serum calcium and vitamin D levels. All the information was recorded via pre-structured study proforma. Results: The study enrolled 147 elderly participants with an average age of 66.82 years. Among the participants, 24 patients (16.3%) experienced Acute Kidney Injury (AKI), with 9.5% having stage-I AKI, 4.8% with stage II AKI, and 2.0% with stage III AKI. Before sustaining the hip fracture, the mean serum creatinine level was 67.04 µmol/L, and following the fracture, it increased to 81.95 µmol/L (p-value < 0.0001). The severity of AKI did not exhibit a statistically significant correlation with the age of the patients. However, there was a statistically significant increase in serum creatinine levels among patients based on the duration of their fractures (p-value < 0.001). Conclusion: The incidence of Acute Kidney Injury (AKI) in elderly patients following hip fractures was found to be 16.3%, with varying stages of severity.

Vegetarian diet induced new onset acute gouty arthritis in a middle-aged genetically predisposed male: A rare presentation

Gout is a metabolic disease characterised by acute or chronic arthritis which is due to deposition of Monosodium urate (MSU) crystals in joints and soft tissues. Classically described as a disease associated with hyperuricemia which may be due to metabolic defect in uric acid production or due to impaired renal excretion.We present a case of 45 year old nondiabetic, non-alcoholic, non-smoker male presented to orthopaedic OPD with complain of pain in right hand and left leg with restriction of joint mobility for past 14 hours.On carefully eliciting the dietary history patient revealed that he was a vegetarian and was on high purine rich diet for past 2 weeks due to family functions and various gatherings. Patient gave the history of consumption of cauliflower, mushrooms, beans along with sweetened carbonated drinks on two consecutive days before the onset of these symptoms.Serum uric acid 4.5 mg/dl, C-reactive protein was 9 mg/dl. To best of our knowledge this is the first case being reported in literatures where purine rich vegetarian diet has induced new case of gout.This kind of gout precipitation after consuming vegetarian diet is rarely reported in literature. This case report emphasizes upon the need of special caution to be taken by persons who are genetically predisposed to gout, while consuming purine rich diet like red meat, seafood, cauliflowers, spinach, rajma, Bengal gram, mushrooms, soft drinks sweetened with fructose.

A Case of Ochronosis with Spontaneous Rupture of Bilateral Achilles Tendon

A 39-year-old male presented to the orthopaedic OPD with complaints of difficulty in walking since 3 months associated with pain over bilateral heel region. The pain was also associated with intermittent popping sound from bilateral ankle joints. Local examination revealed bilateral loss of Achilles tendon contour along with increased range of dorsiflexion and tenderness. Thompson squeeze test and O’Brien needle test were positive indicating rupture of Achilles tendon.

Clinical, Metabolic, and Radiological Risk Factors in Individuals With Plantar Heel Pain From a South Indian Population: A Cross-Sectional Observational Study.

Background One of the most common conditions seen in an orthopedic outpatient clinic is plantar heel pain (PHP). Studies analyzing various risk factors and their association with the development of PHP have been performed primarily in the Caucasian population, and no study has noted any association between the magnitude of various risk factors and their correlation to theseverity of PHP. Hence, we performed a prospective cross-sectional observational study in a select South Indian population presenting with PHP to a tertiary care center. Methods All adult patients presenting to the orthopedic OPD between July 2019 and July 2020 were screened for unilateral PHP and were included after meeting the eligibility criteria. Age, sex, body mass index (BMI), random blood sugar (RBS), uric acid, thyroid-stimulating hormone (TSH), and vitamin D3 were measured as demographic and metabolic parameters. Heel pad thickness, calcaneal spurs, and plantar fascial thickness were noted radiographically. Clinically, the wall-toe distance by weight bear lunge test of each foot was noted, and the severity was measured by the foot functional index (FFI). Results Among the 40 participants, the mean age was 44 (±10.9) years. The average BMI was 30.1 (27.02-32.95). No significant association was noted between the biochemical parameters and the occurrence of PHP. The plantar fascial thickness (PFT) and heel pad thickness (HPT) were thicker than the asymptomatic foot by 1.01 (0.60 - 1.30) mm and 0.79 (0.4-1.7) mm, respectively, which was statistically significant (p<0.001). The heel cord length was found to be reduced by 0.86 (0.6-1) cms, which was statistically significant (p<0.001). The average FFI score was 123.07 (±15.57), and the FFI score percentage in individuals was 53.5% (±6.77).None of the above risk factors showed any significant correlation to the intensity of clinical symptoms measured by FFI (p>0.05). Conclusion Participants had a high BMI and a higher percentage of females. There was a significant increase in PFT and HPT thicknessand a significant reduction in gastrocnemius flexibility when compared to the asymptomatic foot. There was no significant association between various clinical, metabolic, and radiological risk factors and the intensity of plantar fasciitis measured by FFI.

PROSPECTIVE RANDOMISED STUDY COMPARING ENDOSCOPIC DISCECTOMY WITH PERCUTANEOUS RADIO-FREQUENCYCOABLATION IN PATIENT WITH CONTAINED LUMBAR DISC PROLAPSE

Background: This study is to compare functional outcome in patients with radiculopathy with contained lumbar disc prolapse treated with endoscopic discectomy and percutaneous radio frequency co ablation. In this study, the radicular pain using VAS score and prospective functional results using SLR test were measured. Materials and Methods: Prospective randomised control study carried out in Department of Orthopaedics from the period Nov 2016 to Nov 2018. Source of data for study was the patients reporting to Orthopaedic OPD who fulfill the inclusion criteria. Total 30 patients were included in the study. Data was subjected to statistical analysis using Statistical package for social sciences (SPSS v 21.0, IBM). Inter group comparison (2 groups) was done using Mann Whitney U test. Intra group comparison was done using Wilcoxon Signed rank test (upto 2 observations) Friedmans (for &gt;2 observations) followed by followed by pair wise comparison using Wilcoxon Signed rank test. Results: The functional outcome in patients treated with radiofrequency coablation are better than patients treated with endoscopic discectomy. Conclusion: Both Radio-frequency co-ablation and percutaneous transforaminal endoscopic discectomy appear to be safe and effective minimally invasive day care treatment option for patients with contained lumbar disc prolapse with radiculopathy.

VERTEBRAL TUBERCULOSIS FOLLOWED BY TRAUMATIC SPINE FRACTURE IN A CHILD -RARE CASE REPORT

Background Vertebral tuberculosis following a spinal trauma is a rare identity presenting as extrapulmonary TB associated with high degree of morbidity in a growing children. The objective of this report is to describe a paediatric case of traumatic spine fracture on the lower thoracic spine with tuberculosis disease. And thus show the importance of identifying the disease as soon as possible, because it is a rare and severe condition that can leave to serious sequelae. Case summery A adolescent boy presents to the orthopaedic OPD with the complaints of unable to walk, evening raise of temperature, loss of weight, deformity of spine since 3 months. Upon detail history, 3 months back child had a traumatic event following which he developed weakness of both the lower limbs. In the subsequent time he started developing evening rise of temperature, lethargy and loss of weight. His mother observed postural alteration, with constant pain in the middle back region with a deformity formation, unable to walk, inability to ex the lumbodorsal spine and pain on touching surrounding skin area. Clinical examination revealed that the child was pale, emaciated and afebrile with weight of 25 kgs. A tender gibbus was present over the dorso-lumbar region. Sensation of perianal region was intact with spasticity of both lower limbs. The bladder and bowel function were spared. No other external signs of inammation were detected. The rest of the physical examination was non-contributory. No prior history of contact with the tuberculosis patient. Mantoux test and Sputum examination was done. Radiologic evaluation done in the form of radiograph and magnetic resonance imaging. ConclusionSpinal tuberculosis is haematogenous in origin, and usually follows pulmonary tuberculosis. The two conditions may occur concomitantly, as is commonly seen in young children. Spinal tuberculosis is usually associated with a poor nutritional status and a depleted immune response. In our patient the source of infection might have been from a latent focus in the hilar nodes of the lung, although the patient denied any previous history of tuberculosis. Possibly after severe trauma the patient's immunity was lowered this has led to spread of the tuberculosis infection and the vertebral fracture hematoma could have provided a nidus for infection.

PREVALENCE OF OSTEOPOROSIS IN WOMEN AGED 35 TO 65 YEARS IN TEA GARDEN COMMUNITY OF JORHAT DISTRICT

Background: 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.Osteoporosis predominantly affects postmenopausal women. The mal-nutrition, and smoking, consumption of liquor and tobacco may have an effect on bone mineral density (BMD) .Osteoporosis occurs in all populations, but not all populations are at equal risk. According to various studies, Asian women have higher predisposition for osteoporosis than their Caucasian people. Reasons attributed for lower bone mineral density (BMD) in Indians include possible genetic differences, nutritional deciency and smaller skeletal size. Smoking or tobacco intake, malnourishment, alcohol has a negative effect on bone mineral density [BMD]. Tea garden people are probably more affected than other communities in the surrounding area as evidence by high attendance of patients with osteoporosis &amp; fragility fractures in Orthopaedic OPD of JMCH. Increase prevalence in the community might be wholly or partly due to poor socio-economic status , poor nutrition, lack of calcium and vitamin d in diet, dark skin and addiction to alcohol. Purpose of the study: to study the prevalence of osteoporosis in middle-aged to elderly tea garden women of Jorhat district. Materials and Methods: In this community based cross-sectional study, BMD (bone mineral density) of 360 female subjects, aged 35 to 65 years, were calculated using quantitative ultrasound bone densitometry.(QUS) In our study 24.7% were Results: osteoporotic, followed by 39.5% were osteopenic and 35.8% had normal BMD. Thus, the prevalence of osteoporosis in our study, in the female population of tea gardens of Jorhat district was 24.7%

When all is not good – managing an adolescent with Osgood Schlatter disease

Anterior knee pain in children above 10 years of age is a part of every orthopaedic surgeon OPD practice. Osgood-Schlatter disease is the most common cause in skeletal of immature athletic children. It is a condition, in which the patellar tendon insertion on the tibial tuberosity becomes inflamed. It tends to occur more commonly in boys and it occurs in the second decade of life ( 10-15 years). It is a self limiting condition and and occurs secondary to repetitive extensor mechanism stress activities such as jumping and sprinting. OSD is a clinical diagnosis, and only radiographic evaluation may be done to confirm the diagnosis. Pain level dictates overall treatment, and management includes symptomatic treatment with ice and NSAIDs, as well as activity modification. &amp; relative rest from inciting activities in association with lower extremities stretching exercises. In this paper we discuss the etiology, presentation, evaluation, and management of osgood schlatter disease. Keywords: osgood Schlatter disease , osteochondritis, anterior knee pain.

Chondroblastoma in a Distal Phalanx of the Great Toe &amp;ndash; A Rare Case Report

Chondroblastoma is a rare benign appearing lesion arising in the epiphysis of long bones in skeletally immature individuals. It is a cartilage-producing neoplasm constituting &lt; 1% of all bone tumors. A 16 years old girl presented to orthopedic OPD of tertiary care hospital with swelling of her left great toe for 3 years. The swelling was insidious at onset and gradually progressed to the present size of 3.5x2.5x2 cm. Radiographic examination shows an osteolytic lesion and coarse trabeculation

To Study the Role of Arthroscopy in Management of Degenerative Osteoarthritis of Knee: A Prospective Study

Background: Degenerative osteoarthritis of the knee joint, is typically the result of wear and tear and progressive loss of articular cartilage. Common clinical symptoms include knee pain that is gradual in onset and worse with activity, knee stiffness and swelling, crepitus. Patients with knee osteoarthritis have decreased levels of physical activity in comparison to their healthy counterparts. Aim: To study the role of arthroscopy in management of degenerative osteoarthritis of knee. Material and methods: A prospective study was carried out among patients having symptoms and signs of degenerative OA knee coming to Orthopedic OPD at Pravara Rural Medical College. Patients more than 50 years of age, medically fit for surgery, failed to improve on conservative treatment and willing to participate were considered for the study. Thus such 30 cases were studied. All cases were treated by arthroscopic interventions. Statistical analysis was done using open epi version 2.3.1. Results: Mean age was 58.7+12.4 years, majority being females 60%. 14% cases had meniscal tear. On Kellgreen and Lawrence’s arthroscopic grading majority had grade II and III. On final outcome on follow up showed excellent results. 48% excellent, 42% good, and 10% fair. Conclusion: Arthroscopic intervention is an effective method for treatment of degenerative osteoarthritis of knee in patients with negligible complications due to its minimally invasive nature and early mobilization. Patients with grade I and grade II degenerative osteoarthritis have good results.

“BRACHIAL ARTERY PSEUDOANEURYSM SECONDARY TO OSTEOCHONDROMA OF PROXIMAL HUMERUS:A RARE CASE REPORT ”

vascular complications of humeral osteochondromas are extremely rare .We describe a rare case of 16 year old boy who presented to orthopedic OPD with complaints of swelling,which on radiological workup revealed sessile osteochondroma with pseudoaneurysm of brachial artery .The diagnosis was based on systematic analyses of plain radiograph of arm,ultrasound,computed tomography and magnetic resonance imaging,as well as local clinical status in form of a pulsating soft tissue mass.This case demonstrates that for all cases of large osteochondromas ,neurovascular complications are to be looked for,even in unusual locations.

Evaluation of Comprehensive Management Protocol for Reduction of the Risk of Fragility Fractures Among Osteoporosis Individuals, Visiting Teaching Hospital, Kolkata

Introduction: Fragility fracture from osteoporosis is a major challenging health problem in aging population in developing countries. In order to reduce the risk of development of osteoporotic fragility fractures authors made a study with high risk individuals, divided into two groups and a comprehensive management protocol had been offered in one group where as conventional management protocol had been offered in other to see the efficacy of such comprehensive management protocol to reduce the risk of occurring fragility fracture over at least three months period among the patients, attended in orthopaedic out patient department of state medical college, West Bengal. Methods: The authors selected 30 diagnosed osteoporosis clients of 50 to 90 years age as per inclusion and exclusion criteria, who attended in orthopaedic OPD in SSKM Hospital, Kolkata, West Bengal, India from 2021April to July2021, carrying highest risk factors of developing osteoporosis. Results: In experimental group, mean post test BMD score is higher than the mean pre test BMD, which is statistically significant as calculated t value is 3.666 at 14 df at 0.05 (p&lt;0.05) level of significances. It indicates that comprehensive management protocol is effective to increase the bone strength. Conclusion: The study of comparison of mean difference values of two groups conclude that comprehensive management protocol can reduce the risk of osteoporotic fracture much efficiently in compared to standard pharmaceutical treatment in a short span of time which is applicable for long term management of osteoporosis.

A study of “rational use of investigations” in a tertiary hospital

Background: Rational laboratory use is defined as effective and correct laboratory use by providing the most appropriate test selection with the right clinical approach in line with the evidence-based data and considering the cost and patient safety. The present study was thus conducted for the prevalence and features associated with rational use of investigations in a tertiary hospital. Aims and Objectives: The objectives of the study were to estimate prevalence of rational use of investigations and its associated confounding factors; to explain the educational approach underlying the study; and to explain how to teach rational approach of investigations so that we reduce the use of unnecessary and inappropriate tests which are not likely to have any ill effects on the patient. Materials and Methods: A cross-sectional study including 100 patients was selected by random sampling from medicine and orthopedic wards and OPD. Results: In our study,we observed 29 different types of clinical and laboratory investigations out of 2155 investigations ordered by physicians before any intervention. These investigations done in 100 patients, among those 39.16% were contributed to the management of patients and 60.83% were not considered to have contributed toward management of patients. Conclusion: Several external and internal factors can promote irrational use of investigation at different stages. Hence, understanding these factors and implementing appropriate measures are key steps to change behavior of prescriber and nursing staff. We must have logic-based flow chart or algorithm in all investigations for diagnosis as a part of good laboratory or good clinical practices.

Supercutaneous plating: A case report of locking plate used as an external fixator

Introduction: Proximal and distal tibial fractures with a compromised soft tissue envelop still pose a treatment dilemma or challenge for the orthopedic surgeon LCPs have advantages of angular stability from the locking-head mechanism and less irritation when compared with traditional external fixators due to their low profiles. Here is a poster case report of the same.Case Report: A 37-year-old male, flouriest, from Badravathi who came to Orthopedic OPD after he had met with a road traffic accident on 23rd November 2020 and sustained injury to left leg. Plain radiograph revealed fracture of left tibia and fibula at the proximal and middle third junction. Arterial Doppler showed long segment poplitial artery thrombosis.As a definitive treatment patient underwent Open reduction and plate fixation of proximal third tibia with thromboembolectomy and venous grafting done. The limb post-operative went into compartment syndrome and emergency fasciotomy of left leg wasdone. Fasciotomy wound got infected and hence Vacuum assisted closure was applied. The same locking plate was removed and used as an external fixator. The External fixation plate for left tibia was removed and the patient was put on patellar tendon bearing cast and is showing good signs of union.Conclusion: For proximal fractures of the tibia, which are treated by external fixation using the LCP plate is a safe and reliable technique and excellent functional outcomes. There is a high rate of union with minimal complications rate. Its advantages also include ease of performing surgery and ease of removing plate after fracture healing. Though the use of locked plates as external fixators is not a generally acknowledged technique by many surgeons still it has become valuable modality in management.

Outcomes of Autologous Blood Injection for Treatment of Tennis Elbow

Introduction: Lateral tendinosis of the elbow, sometimes called tennis elbow, refers to the degenerative process in the common source of the extended group of forearm muscles. In orthopedic clinics, it is the most prevalent cause of elbow discomfort and pain. The condition caused by repeated muscular motions is a typical cause of elbow discomfort.&#x0D; Objectives: To assess the clinical and functional outcomes of autologous blood injection for the treatment of tennis elbow.&#x0D; Methodology: This is a hospital based cross-sectional study, conducted in Birat Medical College teaching hospital. Here, the patients diagnosed with a Tennis elbow in orthopedic OPD during the study duration of September 2020 to August 2021 were included in the study. Total 93 samples were studied. Two ml of the patient's blood has withdrawn from the right antecubital vein and has been injected around the affected common extensor tendon origin. Data was analyzed using SPSS version 23.&#x0D; Results: Total Ninety Three (59% females, 41% male) patients were treated with the diagnosed concerned disease. The mean age of the patients was 45.39 ± 10.109 years. At the end of the trial, 90% of the patients were satisfied fully with the treatment. The overall performance of the regression model is significant in all scenarios.&#x0D; Conclusion: Given the satisfactory results, the blood injection in question can be deemed a suitable medication alternative to the conventional therapy.

A PROSPECTIVE COMPARATIVE STUDY TO EVALUATE FUNCTIONAL OUTCOME IN ANKLE SPRAIN INJURY GRADE I AND GRADE II WITH PARTIAL AND COMPLETE IMMOBILIZATION METHODS

Background: Acute ankle injuries are one of the most common injuries in orthopaedic department. However, there is still lack of standardized evidence-based treatment. Therefore, the aim of our study was to compare and evaluate the functional outcome of Partial And Complete Immobilization Methods. Comparative evaluation of Functional outcome in ankleObjective: sprain patient treated with partial and complete immobilization and to identify factors affecting the functional outcome in patients with ankle sprain. Methodology- A prospective comparative study was designed from 1st jan 21 to 30th oct 21 49 patients fromMaterials and Methods: orthopedic OPD was selected whom were presented with the ankle sprain and ready to give consent irrespective of their gender. Lower Extremity Functional Scale(LEFS) and visual analogue scale (VAS) were observed at pre-treatment and post treatment at 1st ,3rd and 6th week were compared in both category. in the present study 35 patients were treated with partial immombilization method and 14 were treatedResult- with complete immobilization. Most of patients were belong to age group of 18-25. 67.3 % patients were male and 32.7% were female. 51% having left side injury while 49% have right side a Lower Extremity Functional Scale(LEFS) and visual analogue scale (VAS) were observed at pretreatment post treatment at 1st ,3rd and 6th week. - From our prospective study, we conclude that conservative management ofConclusion- ankle ligament injuries (grade I, II) is a safe and effective method of treatment. And partial immobilization is better than the complete mobilization.

Distal Ulna Giant Cell Tumor: A Case Report

Introduction:Long bone giant cell tumors have been documented in the literature in a large number of cases. A patient with a large giant cell tumor in the distal ulna is described. With a reported prevalence of 0.5 to 6%, this is extremely rare. Case Presentation:A 16-year-old male presented to the orthopedic OPD with pain and swelling in the wrist. A diagnosis of distal ulna giant cell tumor was made after a histological examination. Intralesional curettage, phenol treatment, and bone grafting were used to treat the malignancy. Conclusion:If a giant cell tumor is detected early and treated aggressively, it has an excellent prognosis. It is critical to be aware of unusual cancer localizations in order to make an accurate diagnosis.

A cross-sectional study of diseases prevailing in an orthopaedic OPD at a tertiary care hospital in the Mumbai metropolitan region

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; The orthopaedic out-patient department of a tertiary care hospital plays a crucial role in the health care system as it attends to a large number of patients. The goal of the study is to observe the etiological patterns of common issues that prevail in an Orthopaedics OPD of a hectic tertiary care hospital, which could in turn help to understand the distribution of illnesses in a particular geographical area.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Analysis of 1605 patient records was carried out from the period July 2020 to December 2020, to assess the orthopaedic out-patient load and prevailing diseases. Initial medical records of the patients were analyzed and the data collected were subjected to statistical analysis using IBM SPSS software version 1.0.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; The primary diagnosis of patients visiting the orthopaedic OPD during the Covid-19 period are observed to be as follows: acute and chronic back ache (27.29%), arthritis (26.23%), joint stiffness (10.03%), ligamentous sprains (9.84%), neck-related problem (6.92), tendinopathies and enthesopathies (6.60%), non-specific body aches (5.11%), post-operative follow-up (4.05%),bone fractures (2.37%), soft tissue injuries (0.93%), and neuropathies (0.62%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; The study presenting the overview of diseases prevailing in an orthopaedic OPD in a tertiary care center could help in formulating better prevention and treatment strategies to overcome such medical conditions irrespective of the presence of a pandemic.&lt;/p&gt;