Orthopaedic Fracture Research Articles

The Cost of Postoperative Infection Following Orthopaedic Fracture Surgery

The objective of this paper is to describe the costs associated with postoperative infection following orthopedic fracture surgery. The data provided is based on a narrative review and an analysis of national claims and discharge databases in the United States. The narrative research specifically evaluated the costs associated with postoperative infections following the treatment of proximal femur, tibia, humerus, and ankle fractures. Two US databases were used to estimate the annual incidence of a deep surgical site infection following fracture treatment and the costs associated with that treatment. Previous studies suggest that the cost of treatment for an infected patient is likely to be at least twice the cost of treating an uninfected patient. However, the current literature is limited to small retrospective reviews focused narrowly on the direct health care sector costs of treatment. Further research is required to better estimate the costs of postoperative infection in orthopedic trauma patients, particularly the nonhealth care sector and indirect costs associated with impairment and lost productivity to the patient and caregiver.

Economic Advantages of Telehealth and Virtual Health Practitioners: Return on Investment Analysis.

BackgroundTelehealth is a disruptive modality that challenges the traditional model of having a clinician or patient physically present for an appointment. The benefit is that it offers the opportunity to redesign the way services are offered. For instance, a virtual health practitioner can provide videoconference consultations while being located anywhere in the world that has internet. A virtual health practitioner also obviates the issues of attracting a specialist medical workforce to rural areas, and allows the rural health service to control the specialist services that they offer.ObjectiveThe aim of this research was to evaluate the economic effects of 3 different models of care on rural and metropolitan hospital sites. The models of care examined were patient travel, telehealth using videoconferencing, and employment of a virtual health practitioner by a rural site.MethodsUsing retrospective activity data for 3 years, a return on investment (ROI) analysis was undertaken from the perspective of a rural site and metropolitan partner site using a telehealth orthopedic fracture clinic as an example. Further analysis was conducted to calculate the number of patients that would be required to attend the clinic in each model of care for the sites to break even.ResultsThe only service model that resulted in a positive ROI for the rural site over the 3-year period was the virtual health practitioner model. The breakeven analysis demonstrated that the rural site required the lowest number of patients to recoup costs in the virtual health practitioner model of care. The rural site was unable to recoup its costs within the travel model due to the lack of opportunity for reimbursement for services and the requirement to cover the cost of travel for patients.ConclusionsOur model demonstrated that rural health care providers can increase their ROI by employing a virtual health practitioner.

Factors influencing performances and indicating risk of falls using the true Timed Up and Go test time of patients with hip fracture upon acute hospital discharge.

To examine the influence and risk of falls of individual factors on timed up and go test (TUG) times using standardized instructions in patients with hip fracture upon discharge from an acute orthopaedic hip fracture unit. Following instructions, the TUG was performed three times with a rollator (standardized aid), as fast as safely possible. Up to a 1-min rest was given after the first and second TUG trial. Multivariable linear regression analysis was used to investigate the factors influencing TUG-times and corresponding logistic analysis was used to investigate factors indicating risk of falls, using a cut-off of 24 s for TUG. A total of 181 patients (122 women), 60 years or older, with a mean (SD) age of 78.1 (9.1) years were studied. The fastest of three TUG trials performed within a mean of 10.0 (5.2) post-surgery days and used in analyses reached a mean of 25.6 (11.0) s. Multivariable regression analysis showed that greater age (B = 0.24; 2.4s more per decade older), a low pre-fracture function level (New Mobility Score <7 points, B = 6.4s more than high level), having a trochanteric fracture (B = 6.2 s, vs. cervical), and the post-surgery day of testing (B = 0.42, 4.2s per 10 days later) were independently associated with using more time for performing the TUG. Correspondingly, the same four factors indicated an increased risk of falls in the logistic analysis. The linear model explained 28% of the variance on TUG, while the accuracy of the logistic model to predict patients having TUG≥24 s was 69%. The age, pre-fracture function, fracture type and post-surgery day of TUG testing were identified as strong factors influencing TUG performances and TUG-times indicating risk of falls in patients with hip fracture. We suggest that these factors be considered when interpreting TUG test results and in further rehabilitation and fall prevention efforts.

Patella Fracture Fixation Via Wide Awake Local Anesthesia No Tourniquet (Walant) Technique

Introduction:Fractures of the patella constitute an estimated 1% of all acute orthopaedic fractures. The fracture fixation is usually performed under general or spinal anesthesia with tourniquet use. We describe a novel approach of anaesthesia for patella fracture fixation using the WALANT technique.Methods:We presented a case of 22 years old male with right knee pain following a road traffic accident. Examination revealed tenderness on his right knee with extensor mechanism failure, and radiograph showed comminuted 3 parts patella fracture, requiring fixation. Adequate information regarding WALANT was given and he agreed.Results:Open reduction and internal fixation were done using tension band wiring (TBW) technique and screw fixation. WALANT mixture was given 30 minutes prior to skin incision. Visual analog score (VAS) was 0 throughout the surgery. He was able to do active range of movement (ROM) of the knee intraoperatively after the fixation.Discussion:The solution used was mixture of 50ml lignocaine 2% (for local anesthesia), 1ml of adrenaline 0.18% (for hemostasis), 10ml of sodium bicarbonate 8.4% (to buffer the solution) and diluted with 50ml normal saline for tumescent anesthesia effect. Safe dosage of lignocaine with adrenaline is 7mg/kg. 10ml of mixture injected subcutaneously over mid-axial longitudinal incision site and 30 ml of mixture injected at patella borders and fracture site subperiosteally. We waited 30 minutes to allow adrenaline to reach maximal vasoconstriction and provide dry operative field. Without usage of tourniquet, we avoid complications such as hematoma and post operation swelling. WALANT also permits active motion of knee intraoperatively, which is particularly helpful in post TBW patella patient.Figure 1 :Intraoperative viewFigure 2 :Intraoperative viewFigure 3 :Xrays post fixationFigure 4 :Xrays post fixationConclusion:WALANT is a safe option for patients undergoing patella fracture fixation. It gave a painless surgical experience to the patient and offer another option for high risk patients for general / spinal anaesthesia.

Minimising aerosol generation during orthopaedic surgical procedures- Current practice to protect theatre staff during Covid-19 pandemic

Covid-19 pandemic is the largest health care crisis of this century. A large number of health care workers have succumbed to this virus. Orthopaedic trauma surgery has changed during the pandemic, by generally treating more patients conservatively. Emergency Orthopaedic surgeries and fracture neck of femur patients still need to be treated operatively for a better outcome. Our paper aims to give an insight into our current practice to minimise aerosol generation during these procedures, thereby reducing the risk of infection to the surgical and anaesthetic team.

Comparing the performance of different open injury scores in predicting salvage and amputation in type IIIB open tibia fractures.

Various open injury scores have been devised to aid the difficult decision of salvage or amputation following open fractures of the lower limb. Our aim of the study was to compare the performance of mangled extremity severity score (MESS), limb salvage index (LSI), orthopaedic trauma association-open fracture classification (OTA-OFC) and Ganga hospital score (GHS) in our population of type IIIB injuries. A total of 219 patients with 225 type IIIB open fractures of the tibia were studied prospectively between July 2016 and June 2017. The decision of salvage or amputation was taken by a combined consensus of senior orthopaedic and plastic surgeons, blinded to the scores. All four open injury scores were calculated by an independent reviewer following initial debridement. The follow-up period was one to twoyears. After final follow-up, there were 193 (85.7%) successfully salvaged limbs, 19 primary amputations without attempt of debridement (8.4%), three primary delayed amputations within 72hours (1.3%) and six secondary amputations after 72hours from initial debridement (2.7%). Of these, fourpatients died within oneyear and were excluded. All four scores performed well for salvage, while GHS was superior when considering amputation. MESS, LSI and OTA-OFC underscored amputations, since these scoring systems award more points for vascular injuries. There were both salvaged and amputated patients around the threshold value of amputation for all scores, which was only acknowledged by GHS in its unique 'grey zone'. It includes patients who are neither easily salvageable nor definitely requiring amputation. The performance of the GHS was superior to MESS, LSI and OTA-OFC in our study, since it was developed for type IIIB injuries and includes the 'grey zone', where decisions need to be undertaken on a case to case basis. GHS has an improved ability to determine amputation in IIIB open tibia fractures.

Effectiveness of Iodophor vs Chlorhexidine Solutions for Surgical Site Infections and Unplanned Reoperations for Patients Who Underwent Fracture Repair

The risk of developing a surgical site infection after extremity fracture repair is nearly 5 times greater than in most elective orthopedic surgical procedures. For all surgical procedures, it is standard practice to prepare the operative site with an antiseptic solution; however, there is limited evidence to guide the choice of solution used for orthopedic fracture repair. To compare the effectiveness of iodophor vs chlorhexidine solutions to reduce surgical site infections and unplanned fracture-related reoperations for patients who underwent fracture repair. The PREP-IT (Program of Randomized Trials to Evaluate Pre-operative Antiseptic Skin Solutions in Orthopaedic Trauma) master protocol will be followed to conduct 2 multicenter pragmatic cluster randomized crossover trials, Aqueous-PREP (Pragmatic Randomized Trial Evaluating Pre-Operative Aqueous Antiseptic Skin Solution in Open Fractures) and PREPARE (Pragmatic Randomized Trial Evaluating Pre-Operative Alcohol Skin Solutions in Fractured Extremities). The Aqueous-PREP trial will compare 4% aqueous chlorhexidine vs 10% povidone-iodine for patients with open extremity fractures. The PREPARE trial will compare 2% chlorhexidine in 70% isopropyl alcohol vs 0.7% iodine povacrylex in 74% isopropyl alcohol for patients with open extremity fractures and patients with closed lower extremity or pelvic fractures. Both trials will share key aspects of study design and trial infrastructure. The studies will follow a pragmatic cluster randomized crossover design with alternating treatment periods of approximately 2 months. The primary outcome will be surgical site infection and the secondary outcome will be unplanned fracture-related reoperations within 12 months. The Aqueous-PREP trial will enroll a minimum of 1540 patients with open extremity fractures from at least 12 hospitals; PREPARE will enroll a minimum of 1540 patients with open extremity fractures and 6280 patients with closed lower extremity and pelvic fractures from at least 18 hospitals. The primary analyses will adhere to the intention-to-treat principle and account for potential between-cluster and between-period variability. The patient-centered design, implementation, and dissemination of results are guided by a multidisciplinary team that includes 3 patients and other relevant stakeholders. The PREP-IT master protocol increases efficiency through shared trial infrastructure and study design components. Because prophylactic skin antisepsis is used prior to all surgical procedures and the application, cost, and availability of all study solutions are similar, the results of the PREP-IT trials are poised to inform clinical guidelines and bring about an immediate change in clinical practice. ClinicalTrials.gov Identifiers: NCT03385304 and NCT03523962.

Displaced Distal Radius Fracture Treatment: A Survey of POSNA Membership.

Distal radius fractures (DRFs) are the most common pediatric orthopaedic fracture, of which 20% are displaced injuries. Displaced metaphyseal DRFs are often treated with sedated or anesthetized reduction. The necessity of reduction treatment of displaced fractures to achieve good clinical outcomes is unclear. The purpose of this investigation was to determine the treatment preferences for DRFs among pediatric orthopaedic surgeons and to determine whether they were uncertain enough in their decisions to randomize treatment. Twenty-eight DRF scenarios in children aged 3 to 10 years were constructed in an electronic survey to represent a spectrum of age, angulation in sagittal and coronal planes, and displacement. The survey was disseminated to the full membership of the Pediatric Orthopaedic Society of North America (POSNA). Respondents could select either a treatment of (a) attempt anatomic reduction with sedation or (b) nonsedated immobilization. Respondents also denoted whether they would be willing to randomize the treatment of each injury scenario. Patient, fracture, and surgeon characteristics were analyzed to develop predictors of treatment recommendations and willingness to randomize treatment. A total of 319 surgeons responded (23% of POSNA membership). Respondents were a characteristic representation of POSNA membership (well distributed by years in practice, 78% academic, 91% whose work is >80% pediatrics, and 84% work with residents). Predictors of sedated reduction were complete displacement [odds ratio (OR), 9.23; 95% confidence interval (CI), 2.27-37.51; P=0.002] and coronal angulation (per 1-degree increase, OR, 1.09; 95% CI, 1.02-1.17; P=0.016), Willingness to randomize was inversely related to larger coronal plane angulation (per 1-degree increase, OR, 0.96; 95% CI, 0.93-0.99; P=0.01). A majority of surgeons were willing to randomize 7 of the 8 scenarios involving complete displacement and shortening, and >64% of surgeons were willing to randomize 5 of these 8 scenarios. POSNA members recommend sedated reduction of DRFs primarily based on existence of complete displacement. Although most completely displaced DRFs would undergo reduction, most surgeons would be willing to randomize the treatment of these injuries. This suggests that most POSNA members do not know whether their recommended treatment for displaced DRFs is necessary or correct. This survey establishes the groundwork for a randomized, prospective trial comparing nonsedated immobilization with sedated/anesthetized reduction in the treatment of displaced pediatric DRFs. Level II-survey study.

Obese trauma patients who sustain orthopaedic fractures experience increased length of stay, ICU admissions and mortality

The rising trend of obesity in the United States has been a growing concern within the healthcare system for decades. Since the early 1960s, the prevalence of obesity has more than doubled among U.S. adults, and one out of every three Americans is now considered obese according to the National Health and Nutrition Examination Survey [1,2]. Significant medical comorbidities have been associated with obesity and increased Body Mass Index (BMI); these include hypertension, dyslipidemia, coronary artery disease, stroke, sleep apnea, type II diabetes mellitus and certain types of cancer.

Bioresorbable Mg-Based Metastable Nano-Alloys for Orthopedic Fixation Devices.

This research has been accomplished using the advanced selective laser melting (SLM) technique as well as HIP post-treatment in order to improve mechanical properties and biocompatibility of Mg- Ca-Sr alloy. Through this research it becomes clearly noticeable that the Mg-1.5Ca-xSr (x = 0.6, 2.1, 2.5) alloys with Sr exhibited better mechanical properties and corrosion potentials. This is more particular with the Mg-1.5Ca-2.5Sr alloy after HIP post-treatment allowing it to provide a desired combination of degradation and mechanical behavior for orthopedic fracture fixation during a desired treatment period. In vivo trials, there was a clear indication and exhibition that this Mg-1.5Ca-2.5Sr alloy screw can completely dissolve in miniature pig's body which leads to an acceleration in growth of bone tissues. Mg-Ca-Sr alloy proved potential candidate for use in orthopedic fixation devices through Our results concluded that Mg-Ca-Sr alloy are potential candidate for use in orthopedic fixation devices through mechanical strength and biocompatibility evaluations (in vitro or In vivo).

An Adjunct Indicator for the Diagnosis of Fracture-Related Infections: Platelet Count to Mean Platelet Volume Ratio.

Introduction: Fracture-related infection (FRI) is a common complication associated with orthopaedic fracture care. Diagnosing these complications in the preoperative setting is difficult. Platelets are a known acute phase reactant with indices that change in accordance with infection and inflammation. The purpose of our study was to assess the diagnostic utility of platelet indices at assessing FRI.Methods: A retrospective review performed for all patients who underwent revision surgery for fracture nonunion between 2013 and 2018. Radiographs were employed to define nonunion. Intraoperative cultures were used to define FRI. Receiver operator characteristic (ROC) curve analysis was used to assess the diagnostic ability of preoperative erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and the platelet count/mean platelet volume ratio (P/V) at recognizing FRI.Results: Of the 53 revision surgeries that were performed for fracture nonunion, 17 (32.1%) were identified as FRI. There were no significant demographic differences between the two cohorts. Patients with FRIs exhibited higher values for ESR (54.82 vs. 19.16, p<0.001), CRP (0.90 vs. 0.35, p=0.003), and P/V (37.4 vs. 22.8, p<0.001) as compared to those within the aseptic nonunion cohort. ROC curve analysis for P/V demonstrated that at an optimal ratio of 23, area under the curve (AUC) is 0.814, specificity is 55.6%, and sensitivity is 100.0%. There was no significant difference in the diagnostic performance of the serum biomarkers but only ESR and P/V had an AUC greater than 0.80. The negative predictive value (NPV) for P/V, ESR, and CRP was 100.0%, 84.6%, and 78.6%, respectively.Conclusion: The P/V ratio may serve as a reliable screening test for FRI.

A systematic review of the effect of regional anesthesia on diagnosis and management of acute compartment syndrome in long bone fractures.

Peripheral nerve blockade (PNB) is a useful tool for pain control in the perioperative period. However, there are significant concerns about the use of PNBs following acute orthopaedic trauma due to the theoretical risk of masking acute compartment syndrome (ACS). This study aims to systematically review the effects of PNBs on diagnosis of ACS following long bone fractures. A systematic review of the literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six studies, all of which were single-patient case reports, met criteria for inclusion in this review. Two studies reported a delay in diagnosis of ACS in the setting of PNB use, while four studies did not. Due to the low incidence of ACS, there is a paucity of literature available on ACS following PNB use in the setting of orthopedic trauma. There is no consensus in the literature about the safety of PNB use in the setting of acute long bone fractures, and this review could draw no conclusions from the literature, as the level of evidence is limited to case reports. PNBs should be administered to orthopedic trauma patients only in strictly controlled research environments, and surgeons should be highly cautious about using PNBs for orthopedic long bone fractures, particularly in cases at increased risk for developing ACS.

Ideal xenograft or a perfect bone substitute?-A retrospective review and analysis of the historical concept of ivory implants in orthopaedics.

Surgical treatment of fractures has evolved with the development of anaesthesia in 1846. Experiments with different implants both organic and non-organic had led to introduction of sometimes extremely peculiar materials coming from different species like ox bone or elephant's ivory. The aim of this article is to present not widely known concept of ivory use in bone surgery that set its foot in the history of orthopaedics and laid foundations for orthobiologic reconstructions. Retrospective analysis of articles and books published between 1846 and 2017 that describe various examples of ivory application in the treatment of fresh fractures, non-unions and reconstruction of joints. Our research shows that ivory to the surgical world was introduced by Friedrich Dieffenbach, founder of the modern plastic surgery. It was also used with different rate of success by many of the famous surgeons of the nineteenth and twentieth century to include Trendelenburg, Billroth, Volkmann, Paget and Hey Groves. Ivory was immensely popular in bone surgery and became material of choice demonstrating amazing biological properties and very low rate of infections. Ivory has served well in successful treatment of various orthopaedic conditions for over 100 years. In this article, we are using history as a stepping stone to examine material that is not rejected by the body and promotes bony healing without increased infection or other complications. It is worth considering further analysis of historically acquired specimens for further development of materials for further orthopaedic fracture and reconstructive techniques.

Miniplate osteosynthesis in fracture surgeries: Case series with review of concepts

PurposeMiniplates were initially developed as targets for foot and hand fractures, but they have been used in the treatment of fixation of small bone fragments, reduction of long bone fractures and non-union treatment, which have been difficult to treat. In this study, the authors used miniplates to treat fractures of the upper extremities, lower extremities, and pelvis obtained good outcomes. Herein, the authors report these good outcomes and review the current concept of miniplates. Patients and methodsForty-two patients treated with miniplates between March 2012 and March 2017 who attended follow-up for > 1 year were included in this retrospective study. Miniplates were selected according to purpose, which was classified into three categories: fixation, reduction, and stability enhancement. For fixation, miniplates were used to fix distal fibular fractures occurring distal to the syndesmosis and treat patellar and olecranon fractures with severe comminution. For reduction, miniplates were used to reduce the tibia during intramedullary nailing in tibiofibular shaft fractures, while reduction was performed in advance of definitive plating fixation in patients with humeral and pelvic fractures. To enhance stability, the miniplate was inserted after autobone graft for atrophic nonunion at the humeral shaft following nail insertion. The validity of a miniplate was analyzed by reviewing the published literature on the use of miniplates in orthopedic fracture surgeries. ResultsBony union was achieved in all cases. No specific postoperative complications were observed; however, mild pain and limited range of motion observed in two patients were resolved after implant removal. Sixteen studies on fracture treatment using miniplates reported clinically fair outcomes. ConclusionMiniplates are not just small metal plates. Depending on the location and treatment of the fracture, the miniplate can effectively fix small bone fragments, help the main plate to maintain the reduction of large bone fragments, and increase the fixation force for nonunion treatment.

Readmissions Are Not What They Seem: Incidence and Classification of 30-Day Readmissions After Orthopedic Trauma Surgery.

To evaluate the causes of 30-day readmissions after orthopedic trauma surgery and classify them based on their relation to the index admission. Retrospective chart review. One large, academic, medical center. Patients admitted to a large, academic, medical center for a traumatic fracture injury over a 9-year period. Assignment of readmission classification. Readmissions within 30 days of discharge were identified and classified into orthopedic complications, medical complications, and noncomplications. A χ test was performed to assess any difference in the proportion of readmissions between the hospital-reported readmission rate and the orthopedic complication readmission rate. One thousand nine hundred fifty-five patients who were admitted between 2011 and 2018 for an acute orthopedic trauma fracture injury were identified. Eighty-nine patients were readmitted within 30 days of discharge with an overall readmission rate of 4.55%. Within the 30-day readmission cohort, 30 (33.7%) were the direct result of orthopedic treatment complications, 36 (40.4%) were unrelated medical conditions, and 23 (25.8%) were noncomplications. Thus, the readmission rate directly due to orthopedic treatment complications was 1.53%. A χ test of homogeneity revealed a statistically significant difference between the hospital-reported readmission rate and the orthopedic-treatment complication readmission rate (P < 0.0005). The use of 30-day readmissions as a measure of hospital quality of care overreports the number of preventable readmissions and penalizes surgeons and hospitals for caring for patients with less optimal health. Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Preterm birth and the future risk of orthopedic fracture.

Preterm birth occurs during a critical period of bone mineralization. We assessed whether preterm birth increases the risk of childhood fracture. We analyzed a cohort of 788,903 infants born between 2006 and 2016 in Quebec, Canada. The exposure was preterm birth (<37 weeks). The outcome was any future hospitalization for fracture before 2018. We estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association of prematurity with fractures in adjusted Cox regression models. We determined if the risk of facture varied by the child's age. The incidence of fracture hospitalizations was higher in preterm children than in term children (17.9 vs. 15.3 per 10,000 person-years). Compared with term, preterm children had 1.27 times the risk of femur fracture hospitalization (95% CI 1.01-1.60) and 2.27 times the risk of assault-related fractures (95% CI 1.37-3.76). Preterm children had 2.20 times the risk of femur fracture between 6 and 17 months of age (95% CI 1.45-3.35). Preterm birth is associated with an increased risk of hospitalization for femur fractures and assault-related fractures. Associations are stronger before 18 months of age. Families of preterm children may benefit from counseling and support for fracture prevention during early childhood.

Implementation of advanced practice nursing for orthopaedic patients in the emergency care context - A study protocol for outcome studies.

To evaluate the implementation of advanced practice nursing in emergency care in Norway for patients with orthopaedic injuries, including hip fractures. The outcomes relate to quality of care and patient trust. A non-inferiority study comparing an advanced practice nursing care model with a standard (physician-led) care model. Data will be collected from patient records and through the Patient Trust Questionnaire, completed by patients. The data will be analysed by descriptive and inferential statistics. Funding for the research was granted in 2015 and the regional ethical committee approved the current study in February 2019. In Norway and the other Nordic countries, advanced practice nursing is still in its infancy, especially in the emergency care context. This study will evaluate advanced practice nursing in this new context. The study will add to knowledge on the quality of care provided for orthopaedic patients with minor orthopaedic injuries or hip fractures as delivered by advanced practice nurses and physicians, respectively. It will also evaluate how well-advanced practice nursing is accepted by patients in this new context.

The role of preoperative oral pregabalin on acute post?operative pain after orthopedic lower limb surgery

Introduction: Postoperative pain after orthopedic surgery has remained a challenging problem, which prolongs hospital stay and early rehabilitation. Pregabalin comes under class of gabapentinoids that have been used in postoperative pain in arthroplasty and spine surgeries but studies regarding its role as preemptive analgesia in orthopedic limb surgeries are very few. Aim: To study the efficacy and safety of pregabalin as preemptive medication for acute postoperative pain management in patients undergoing orthopedic lower limb fracture surgeries. Materials and Methods: A randomized double blinded prospective study was undertaken. Sixty patients were enrolled with age between 18–70 years and were divided into 2 groups. Group A ­ received 150mg of oral pregabalin capsule, Group B – received matched colour empty capsules. Standard spinal anaesthesia was given. Breakthrough analgesia was given with Inj. Diclofenac 1.5 mg/kg i/m. Assessment of pain was done with visual analog scale (VAS). Results: There was marked reduction in postoperative VAS score in group A and the amount of breakthrough analgesia needed in the 24-hour postoperative period was also much lower in the Group A as compared to the Group B. Conclusion: 150mg of oral pregabalin as preemptive medication offers satisfactory postoperative analgesia in orthopaedic lower limb fracture surgeries with very few undesirable side effects. Keywords: Postoperative pain, Pregabalin, Gabapentinoids, Preemptive analgesia, Diclofenac, Visual analog scale.

Evaluation of efficacy of pain relief by transdermal diclofenac versus transdermal ketoprofen in patients undergoing hip fracture surgeries

Introduction: Transdermal patches are simple and painless method for providing postoperative analgesia while avoiding risks associated with parenteral administration. The aim of the study was to evaluate the efficacy and safety of transdermal patch of ketoprofen in comparison to diclofenac patch for postoperative analgesia in patients undergoing orthopedic hip fracture surgeries. It is a randomized single blind study.Methods: Seventy patients were randomly allocated to receive either ketoprofen or diclofenac patch at the end of surgery under spinal anaesthesia. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 21.0 statistical Analysis Software.Results: In group D the VAS score immediately after the operation was 1.51±0.41 and in group K it was 1.58±0.41, which was significantly nonsignificant (p>0.05 value). We also observed that VAS score remained significantly low in ketoprofen group at 2 hour, 12 hour and 24 hour after the operation (p0.05)Conclusions: Both ketoprofen and diclofenac transdermal patch are effective for postoperative analgesia but less number of patients required rescue analgesic in ketoprofen group.

A Comparative Study of Management of Femoral Shaft Fracture in Children: A Prospective Study

Context: Femoral shaft fracture is the most common major pediatric orthopedic fractures and treatment of them carries a lot of controversies. Aims: The aim of this study was to compare the functional outcome after internal fixation with titanium elastic nail and stainless steel Kirschner wire in unstable femoral shaft fracture in children. Settings and Design: This prospective study was conducted at Sharda University between December 2010 and December 2017 and were followed up for 12 months. Materials and Methods: A total of hundred children between the ages of 2–14 years having closed unstable fracture of the femoral shaft were included in the present study. Fifty children were managed with titanium nails (Group 1) and the same number of children was managed with stainless steel Kirschner wires (K-wires) (Group 2). Functional outcomes were evaluated using the criteria of Flynn et al. Statistical Analysis Used: Statically analysis was limited to calculation of percentage of patients who had unions, malunions, delayed unions, or nonunions and excellent, good, and poor outcomes. Results: Based on the Flynn criteria, 92% of patients had excellent results, 8% had satisfactory results, and no one showed poor results. There was no clinically significant difference between the two groups with respect to time to union, functional outcome, and complication. Conclusion: The clinic-radiological results were not significantly different between titanium nail and Kirschner wire at 1-year follow-up as observed by our study. The cost of Kirschner wire is one-third the cost of titanium nail.