Results In Terms Of Pain Research Articles

Clinico-radiological and functional outcome of Neer’s 2 part, 3 part and 4 part proximal humeral fractures in elderly treated by conservative management in a tertiary care centre of North India

<p><strong>Background:</strong> Treatment of proximal humeral fractures is challenging. Despite a rising incidence in proximal humeral fractures, there is still no evidence for the best treatment option, especially for the elderly patients. The aim of this prospective study was to evaluate the radiological in terms of union and functional outcome in terms of pain, range of motion of conservatively managed proximal humeral fractures in elderly patients.</p><p><strong>Methods:</strong> This was an observational prospective study of 35 patients aged above 65 years with proximal humeral fractures including 2 part, 3 part and 4 part based on Neer’s classification, treated by conservative method. Functional outcome was assessed by using Constant score at follow up of 1 year.</p><p><strong>Results: </strong>Out of 35 patients, 21(60%) were female and 14 (40%) were male with mean age of 76.8 (range 65 to 91years). On the basis of Neer’s classification, majority of patients (15, 42.8%) had 3 part fracture. Radiological union was achieved within 13 to 24 weeks, with an average of 18.4 weeks. Out of 35, 5 (14.3%) had<strong> </strong>excellent outcome, 8 (22.8%) had good functional outcome, 16 (45.7%) had moderate outcome, 6 (17.14%) had poor outcome. The results were comparable with the existing literature.</p><p><strong>Conclusion: </strong>In the present study, our data shows that the proximal humeral fractures can be effectively managed conservatively in the elderly patients. Two part fractures have best functional outcome and four part fractures have highest rate of complications.</p>

Efficacy of threading lasso fixation in repairing partial articular supraspinatus tendon avulsion lesions: a retrospective study

BackgroundThe partial articular supraspinatus tendon avulsion (PASTA) lesion repair remains a topic of debate. We have performed in situ repair of PASTA lesions using a potentially viable threading lasso fixation technique. This retrospective case series aimed to evaluate the clinical outcomes of PASTA lesion repair using threading lasso fixation. To the best of our knowledge, this is the first study to review this technique and its outcomes in terms of pain and upper extremity function.MethodsTwenty-five patients with PASTA lesions who were treated with threading lasso fixation were reviewed. All patients were followed up for at least 1 year. Preoperative and follow-up data were retrospectively collected and reviewed. Clinical outcomes were assessed to evaluate the efficacy of the surgery.ResultsThere were no postoperative complications. The average follow-up period was 25.7 (22–27) months. At the last follow-up, all patients underwent follow-up magnetic resonance imaging; only two cases showed a partially healed tendon and no case converted to full-thickness tear. Furthermore, shoulder pain decreased and mobility was recovered, with statistically significant differences in all scoring measures. Specifically, the mean visual analog scale score decreased from 5.4 ± 1.2 before surgery to 1.1 ± 0.8 at the last follow-up (t = 14.908, P < 0.01), and the mean American Shoulder and Elbow Surgeons Shoulder Assessment Form score improved significantly from 51.6 ± 6.4 to 89.3 ± 5.2 (t = 22.859, P < 0.01). Additionally, the mean University of California Los Angeles score improved from 17.8 ± 3.5 preoperatively to 32.3 ± 1.4 (t = 19.233, P < 0.01).ConclusionsArthroscopic repair using threading lasso fixation is a novel transtendinous technique for patients with partial articular supraspinatus tendon avulsion. Tendon integrity is preserved with this method, which may result in improved function. Overall, threading lasso fixation technique is an effective treatment.

The Role of Cervical Muscles Morphology in the Surgical Treatment of Degenerative Disc Disease: Clinical Correlations Based on Magnetic Resonance Imaging Studies.

Cervical spine musculature still remains a less studied component of the cervical spine anatomical compartments, although it plays a significant role in the mobility of the head and the preservation of cervical spine alignment. The goal of this study was to extract any significant information from the literature regarding the role of cervical spine muscles morphology in the outcome of surgically treated patients for degenerative disc disease (DDD) based on preoperative magnetic resonance imaging (MRI) studies. Eleven clinical case series were found, from which four were prospective and seven were retrospective. Six studies were concentrated on anterior approaches and five studies on posterior approaches in the cervical spine. In posterior approaches aiming at the preservation of muscles attachments and overall less surgical manipulations, results on cervical lordosis, axial pain and patient’s functionality were found superior to traditional laminectomies. The study of cross-sectional areas (CSAs) of deep paraspinal muscles in the cervical spine could add significant information for the spine surgeon such as the prediction of adjacent level disease (ALD), fusion failure, axial pain persistence, postoperative cervical alignment and patient’s postoperative functionality. It seems that MRI studies focusing on muscle layers of the cervical spine could add significant information for the spinal surgeon regarding the final surgical outcome in terms of pain and function expression. Larger multicenter clinical studies are a necessity in defining the role of the muscle component of the cervical spine in the surgical treatment of DDD.

Comparison of physical therapy and arthroscopic partial meniscectomy treatments in degenerative meniscus tears and the effect of combined hyaluronic acid injection with these treatments: A randomized clinical trial.

Symptomatic degenerative meniscus tears are common in middle and old age. Arthroscopic partial meniscectomy (APM), physical therapy (PT) and hyaluronic acid injection (HAI) are the most commonly used treatment options. The aim of our study is to compare the effectiveness of APM and PT in degenerative meniscus tears and to investigate the effect of HAI with a prospective, randomized, single-blind study. The study included 192 patients with symptomatic degenerative meniscus tears. The patients were randomly divided into the four groups. The first group consisted of patients who underwent APM, the second group received HAI with APM, the third group received PT, and the fourth group received HAI with PT. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Visual Analog Scale (VAS) scores, and range of motion (ROM) values were used for evaluation. There was no difference between four groups according to age, gender, BMI, affected side, grade of osteoarthritis. In the 4 groups, WOMAC and VAS results at the 2nd and 6th months were better than pre-treatment. There was no difference between the groups in terms of WOMAC and VAS. In terms of ROM, the results were found better in PT group (Group 3, Group 4) at the 2nd and 6th months. However, the results were found worse in APM group (Group 1, Group 2). In addition, it was found that HAI applied with APM and PT had no effect on VAS, WOMAC, and ROM. It was determined that the increase of knee osteoarthritis negatively affected both the results of APM treatment and PT. VAS, WOMAC, and ROM results were found worse in patients with stage 3 osteoarthritis than grade 1 and 2, but there was no difference between grade 1 and 2. APM and PT give good results in terms of pain and functional results. However, ROM limitation develops after APM. Conversely, there is an increase in ROM after PT. Administration of HAI with these treatments has no effect on the results. PT is an easily applicable noninvasive method. Adding HAI to the treatment has no effect on the results and increases the cost.

A Comparative Study of Dexmedetomidine as Adjuvant to 0.5% Bupivacaine in Erector Spinae Plane Block for Perioperative Analgesia in Patients Undergoing Percutaneous Nephrolithotomy

Context: Patients undergoing percutaneous nephrolithotomy (PCNL) experience considerable post-operative pain. Perioperative pain control for PCNL using regional anaesthesia techniques like erector spinae plane block (ESPB) helpsin better outcome in terms of pain, fentanyl requirement. It also indirectly helps in faster recovery and early discharge from hospital. Aims: To assess and compare perioperative pain control provided by ESPB with 0.5% bupivacaine and dexmedetomidine as adjuvant to it. Settings and Design: This randomized case control study was undertaken in a tertiary care centre. 60 patientsplanned for elective unilateral PCNL over a period of 15 months. Patients were randomized into two groups (Group B and group D) using envelope method. Patients were compared for fentanyl consumption, duration and effectiveness of analgesia obtained. Methods and Materials: ESPB was administered pre operatively under ultrasound guidance at the level of 10th thoracic vertebrae. Needle tip was visualised above transverse process of 10th thoracic vertebra. Position was confirmed by hydro dissection on injecting normal saline under ultrasound and drug was injected.Patients were assessed for painat specific time intervals. Total opioid consumption was noted. Data obtained was recorded and analysed. Statistical analysis used: Statistical analysis was performed by SPSS software v.23.0. Oneway analysis of variance, Bonferroni correction, Chi square test was used. P value of &lt;0.05 was considered statistically significant. Results: Dexmedetomidine as adjuvant to local anaesthetic agent improves the quality and prolongs the duration of analgesia. It also decreases total fentanyl consumption. Conclusion: ESPB provides adequate analgesia for PCNL. Addition of dexmedetomidine decreases fentanyl and sevoflurane consumption meanwhile increasing duration of analgesia.

Pain outcomes following total knee replacement

Purpose: Total knee arthroplasty (TKA) is the final treatment option for end-stage knee osteoarthritis. While it is expected to resolve pain, 15-40% of patients have persistent pain 6 months after surgery that is not otherwise explained (e.g., infection, joint loosening). While the majority of patients undergo only one knee replacement, a substantial fraction of patients has both knees replaced, and these are typically staged (performed sequentially). The implications of having two TKAs in terms of pain outcomes, and whether there is a proportion of patients who do not achieve pain resolution after two TKAs is unclear.

Does proximal migration of the first metacarpal correlate with remaining pain after trapeziectomy?

Proximal migration of the thumb metacarpal has been suggested as a possible cause of remaining pain after trapeziectomy for trapeziometacarpal joint osteoarthritis. The aim of this study was to investigate if proximal migration after trapeziectomy is associated with a poorer long-term outcome in terms of pain and objective physical variables. We retrospectively examined 91 thumbs in 65 patients after a mean of 10 years following trapeziectomy with or without ligament reconstruction and tendon interposition. Proximal migration of the thumb metacarpal was measured on plain lateral radiographs of the thumb and correlated to visual analogue pain scale (VAS), thumb range of motion and strength. Most thumbs had a severe proximal migration of the first metacarpal, the mean scaphoid metacarpal distance was 2.7 mm. Most patients reported no or little pain, median VAS was 0 at rest and 1 after load. There were no differences in reported VAS pain at rest or after load between patients with severe (<2 mm scaphoid metacarpal joint space) or less severe (≥2 mm metacarpal joint space) proximal migration. Patients that reported more pain (VAS >2) did not exhibit more migration than patients reporting less or no pain. Thumbs with severe migration had weaker key pinch (3.4 vs. 4.6 kg, p = 0.008) and grip strength (15 vs. 21 kg p = 0.002). We conclude that proximal migration most likely does not cause residual or recurrent pain after trapeziectomy.

CLINICAL EVALUATION OF PANIYA KSHARA IN MUTRAKRICHHA W.S.R. TO LOWER URINARY TRACT INFECTION: A CONTROLLED RANDOMISED CLINICAL TRIAL

Mutrakrichha is a disease in which Mutra is voided with much Dukha (discomfort). The word Mutrakrichha comprises of two words, Mutra and Krichha, which means Krichha pravritti of Mutravahana (difficulty in micturition). Mutrakrichha comes under the disorders of Mutravaha srotas and mainly deals with Shool (pain) and Krichhata (dysuria). Mutrakrichha can be an independent disease as well as associated symptom in other disease. In the contemporary science, the disease with similar signs and symptoms are Lower urinary tract infection. Lower urinary tract infection is the most common infection known to mankind and a common condition seen in general practice. Urinary tract infection affects more than 150 million people every year worldwide. It is well explained by all the Acharyas. Charaka has described eight types of Mutrakrichha. Acharya Sushruta in Uttra-Tantra has separately described Mutraghata and Mutrakrichha. Acharyas have mentioned drugs having antibacterial and diuretic property in Mutrakrichha chikitsa. Paniya kshara is an age old treatment modality used since ancient times. To evaluate the role of Paniya kshara in Mutrakrichha, a total of thirty patients were selected with complaints of painful micturation, fever, urgency and tenderness. Patients were given Paniya Kshara. The study revealed highly significant results in terms of pain, fever, urgency and tenderness.

Management of fibrous dysplasia of the femur neck in a child by PHILOS Stabilization, curettage, and bone grafting: A case report

Fibrous dysplasia has a considerable risk of pathological fractures particularly in proximal femur in younger age group. These are challenging to treat, especially in pediatric population. Several treatment modalities have been proposed, each having its own pros and cons. Attention should be given in pediatric population in choosing technique and selection of implants to preserve growth of the limb and to prevent implant prominence and soft tissue irritation. We are reporting a case of pathological neck of femur fracture secondary to fibrous dysplasia, in an 11-year-old obese boy, managed with curettage, iliac crest bone grafting and osteosynthesis with PHILOS plate (a plate routinely used in adults for humerus neck fractures). At 6 months follow-up, he shows a good consolidation of iliac crest graft at fracture site with stable implant and an excellent functional outcome in terms of pain and range of motion, without any radiological sign of recurrence.

Study of Functional Outcome in Terms of Pain and Range of Movements in Degenerative Rotator Cuff Tear by Transosseous Sutures in Elderly

Introduction: The surgical treatment of Rotator cuff repair ranges from open to arthroscopic assisted mini open repair to full arthroscopic repair. The anterior approach or lateral deltoid approach has its advantages and disadvantages depending upon the site and the extent of the rotator cuff tear. Aim and objective: To assess the functional outcome of mini-open anterolateral approach for degenerative rotator cuff tear by trans-osseous sutures in elderly in terms of pain and range of movements. Methodology: The present study was prospective observational study conducted on Patients with degenerative rotator cuff tears presenting at Department of Orthopaedics. Patients underwent mini-open anterolateral approach for degenerative rotator cuff tear by trans-osseous sutures. Follow-up of patients was done immediate after suture removal, at six weeks, at twelve weeks, twenty-four weeks following the surgery. Pre-op and Final follow up evaluation was done for each patient using VAS scale and range of movement. Shoulder index using ASES scores were noted. Results and discussion: Majority of the patients (52%) were males and (48%) were females. 44% cases were between 61 to 70 years of age. In our study in follow up at 6,12, 24 weeks, range of motion was found to be increasing during subsequent follow ups. (p<0.001) The average ASES scores improved from 20.83 to 81.15 (Range 58-67) at final follow up (p<0.0001).

The Efficacy of Injections for Partial Rotator Cuff Tears: A Systematic Review.

(1) Background: Even though rotator cuff tears are the most frequent tendon injuries in adults, the effectiveness of conservatively treated partial-thickness tears still remains a matter of debate. The purpose of this review is to compare corticosteroid injections to other drugs in the treatment of partial rotator cuff tears, focusing on the effectiveness of this therapeutic modality in terms of pain and shoulder functionality. (2) Methods: A systematic electronic search was performed using the PubMed (MEDLINE), EMBASE and Cochrane Library databases. All studies comparing the use of corticosteroids and other infiltrative techniques in the treatment of partial lesions (excluding studies that considered subacromial impingement as inclusion criteria) were pooled, data were extracted and statistically analyzed. (3) Results: Nine studies were included in this systematic review. Those studies, composed by a total of 494 shoulders treated, have been published from 1985 to 2019. All compared techniques have shown a significant improvement over baseline condition. PRP (Platelet Rich Plasma) injections have been shown to be significantly more effective in both functional and pain control only in the long term. (4) Conclusions: None of the techniques prevail indisputably on the others. Anyway, the treatment of partial rotator cuff tears with PRP injections seems to lead to significantly better outcomes in terms of pain and shoulder function in long term follow up. Whereas in short and medium term follow up, PRP injections was superior only in terms of shoulder function. The small number of studies on prolotherapy did not enable us to provide an opinion on the outcomes of this technique.

Functional outcome of the treatment of AO-ASIF type C distal humerus fracture using Lambda plate

Introduction: Although the use of two plates for the treatment of type-C distal humerus fracture is popular, site of plate placement still is under debate. Use of Lambda plate for the fracture treatment can be easier and settle the dispute. This study aims to evaluate the functional outcome of the surgery using Lambda Plate. This can be a reference for surgeons and helps them make the decision about choice of implant for type C distal humerus fracture treatment among Nepalese people.&#x0D; Methods: This interventional study used Lambda plate for the treatment of type C fracture of distal humerus. Patients were examined at 4, 12, and 24 weeks respectively for the measurement of the outcome. Visual analogous scale was used for assessment of pain, range of motion for functional recovery and Mayo Elbow Performance Score was used for the assessment of functional outcome. Paired-samples t-test and linear regression was used to for data analysis.&#x0D; Results: Functional outcome at the last follow-up was excellent in 24(53.33%) patients, good in 18(40%) patients and fair in 3(6.67%) patients. Range of motion of elbow increased significantly with every follow-up (p-value &lt;0.001). Average angle of flexion at last follow-up was 117.53°±11.74 while loss of extension was 7.53°±4.86. Average number of patients had their fracture union at 19.84±2.38 weeks. There was no association of age, sex and union weeks with functional outcome when measured with MEPS.&#x0D; Conclusion: Fixation of distal humerus fracture by using Lambda plate gave excellent and satisfying outcome in terms of pain, range of motion and objective functional outcome.

Comparison of functional outcome between local steroid injection and percutaneous release of trigger finger

The best modality for management of correctable triggering of fingers has remained controversial. This study focuses on the outcome of 2 minimally invasive techniques, the percutaneous release of A1 pulley and the local Corticosteroid injection. Aim of this Prospective study is to compare the functional outcome in terms of pain, remnant and recurrent triggering over a period of 6 months, in patients of trigger finger, treated with percutaneous release and steroid injection. For this study, 100 patients of grade 2 and 3 triggering of fingers underwent percutaneous release or steroid injection (50 each) randomly, and they were assessed repeatedly over a follow up period of 6 months. The analysis was done using a Green’s grading, Roles-Maudsley score and VAS Score. Results were analysed with graphical representation. Percutaneous release gave an excellent relief from triggering with no recurrence, and 98% success rate. Steroid injection had only 56% success rate with 22% recurrence at the end of 6 months (higher with grade 3). The roles Maudsley score was almost equal at the end of 6 months, with 98% patients having good and excellent results in both groups. Pain relief was immediate after the steroid injection but there was a relapse in a few patients by the end of 6 months (14% developed VAS Score 4 and higher). It took 1 month for pain to get relieved in the percutaneous group, but the relief was well sustained (96% had absolute relief in percutaneous group vs 66% in steroid group). The percutaneous release should be the preferred modality in all grade 2 and 3 trigger fingers with adequate analgesia for the 1st week post- procedure.

Effects of fluoroscopy-guided conventional radiofrequency ablation in dissatisfed patients after total knee arthroplasty

Objective: Osteoarthritis is a chronic progressive disease that can be treated with several conservative and surgical methods. One commonly used surgical method is total knee arthroplasty. However, some patients have persistent annoying pain afterward. The aim of our study was to investigate the effectiveness of radiofrequency treatment accompanied by fluoroscopy in patients who underwent total knee arthroplasty and had no other reason for their persistent pain. Material and methods: Twenty-eight patients who had undergone total knee arthroplasty for osteoarthritis were retrospectively analyzed and included in the study. Patients who are dissatisfied after total knee arthroplasty procedure, were performed radiofrequency ablation by fluoroscopy. All patients were examined in terms of visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores preoperatively and 2 weeks and 1 and 3 months postoperatively. Results: The VAS and WOMAC scores at postoperative week 2 and months 1 and 3 were statistically significantly different than the preoperative values for all patients (P=0.001). Conclusion: Patients with persistent pain after total knee arthroplasty obtained good results in terms of pain and knee function after conventional radiofrequency ablation accompanied by fluoroscopy but more studies with more patients are needed.

Prospective Nonrandomized Analytical Comparative Study of Clinicoradiological Relationship and Quality of Life between Lumbar Interbody Fusion and Posterolateral Lumbar Fusion.

Study Design:This prospective, nonrandomized, analytic comparative study analyzed the outcome of 100 patients who underwent spinal fusion surgeries (Posterolateral fusion (PLF) and posterior lumbar interbody fusion [PLIF]) with 6 months of follow-up.Objective:The aim of our study was to compare clinicoradiological outcome of the lumbar spinal fusion surgeries (PLF vs. PLIF/transforaminal lumbar interbody fusion [TLIF]), to assess the quality of life pre- and post-operatively in all patients, and to compare the results within the groups.Summary of Background Data:We retrieved the articles related to posterolateral fusion (PLF) and PLIF/TLIF through computer-assisted PubMed and Cochrane database search. Most of the studies in previous literature did not show any significant difference in the success of fusion between the two groups. However, the global outcome in terms of clinical and radiological parameters was good in all the studies.Materials and Methods:Senior neurosurgeons who are part of the study treated 100 patients presented with degenerative disc disease (DDD). Patients underwent two types of spinal fusion surgeries: Posterolateral fusion (PLF) and PLIF/TLIF, and those two groups were compared for clinicoradiological outcome, successful fusion, and quality of life at 6 months of follow-up. Results were analyzed statistically using SPSS version 21.0 and presented in terms of frequency, percentage, mean, and standard deviation. Measurements were compared between groups using the Student's t-test (independent and paired) for normally distributed variables. Percentage was compared with Chi-square test in various parameters. Statistical significance was determined with P values; P < 0.05 was considered statistically significant.Results:Patients aged between 30and 65 years with lumbar DDD who met the inclusion criteria were included in the study. Patients were operated for 1–3 vertebral levels and showed clinical satisfactory outcome on visual analog scale (P = 0.004) and modified-Oswestry low back pain disability questionnaire (Oswestry disability index) (P = 0.000) at 6 months as compared to the preoperative data, which was statistically significant. Radiological outcome in terms of lumbar lordotic angle (LLA, P = 0.000) and ratio of disc space height (DSH) and height of immediate superior vertebral body (P = 0.000) at 3 months of follow-up was also statistically significant. All of our patients showed a well-placed implant (screws and cage) in the follow-up period. Our patients showed successful fusion more in the PLIF group (81.25%) as compared to the PLF group (67.30%), but those results are not statistically significant (P = 0.112), and all of our patients showed statistically significant difference (P = 0.000) in quality of life score at 6 months of follow-up when compared with the preoperative score.Conclusions:We concluded from our study and after the review of literature that the patients with lumbar DDD should undergo spinal instrumentation surgery either PLF or PLIF as per the requirement as these surgeries provide good clinical and radiological outcomes in terms of pain, disability index, LLA, and maintenance of DSH. Although both the groups have few degrees of risks and complications, these are not major one and can be managed easily. The fusion rates are similar in both the groups (PLF and PLIF). Quality of life index showed significant difference within 1 week, after 3 months, and after 6 months of surgery in all of our patients.

TO COMPARE THE EFFECT OF PRE-EMPTIVE DEXAMETHASONE AND METHYLPREDNISOLONE EITHER BY INTRAMUSCULAR OR BY SUBMUCOSAL ROUTE FOR THE POSTOPERATIVE CONTROL OF PAIN, SWELLING, AND LIMITED MOUTH OPENING FOLLOWING THE EXTRACTION OF IMPACTED THIRD MOLARS

Introduction: The surgical removal of impacted mandibular third molars is an invasive procedure that involves extensive tissue trauma and a considerable postoperative inflammatory response. Although the inflammatory process is necessary for healing when exacerbated it may cause pain, swelling and limited mouth opening. Corticosteroids are among the most widely employed pre-operative medication administered for the control of such complications. Objective: To compare the effects of single dose of pre-operative Injection Dexamethasone versus Injection Methylprednisolone via Intramuscular or Submucosal route for controlling the post-operative pain, swelling and limited mouth opening in the removal of impacted mandibular third molars. Material and Method:. The present study was conducted on 40 healthy adult patients with bilaterally symmetrical impacted mandibular third molar, reporting to the Department of oral and Maxillofacial Surgery of Guru Nanak Dev Dental College and Research Institute, Sunam. Clinically, pain, swelling, mouth-opening were evaluated pre-operatively as baseline and post-operatively on 1st, 3rd and 7th post-operative days. Results: The results of our study are summarized below: In Group A: Submucosal injection of dexamethasone gave better results in controlling pain, swelling and trismus in comparison to Intramuscular injection of dexamethasone. In Group B: Submucosal injection of methylprednisolone showed better results in terms of pain, swelling and trismus when compared with Intramuscular injection of methylprednisolone. In Group C: Intramuscular injection of dexamethasone gave better results in terms of pain and mouth opening but, swelling was reduced with Intramuscular methylprednisolone. In Group D: Submucosal injection of dexamethasone showed better results in terms of pain, but swelling and mouth opening was reduced when methylprednisolone was used submucosal. Conclusion: The results of our study concluded that Dexamethasone is better than Methylprednisolone in controlling post-operative sequelae after third molar surgery. This can attributed to the higher potency and longer half-life and less sodium retaining capacity of dexamethasone than methylprednisolone. The results of our study also concluded that submucosal route of administration of drug is better than Intramuscular route because of the repository effect of the submucosal route, also this route is beneficial to the patient as well to the surgeon because needle penetration is done in the pre-anesthetized area, also it is an easy technique to be mastered by the surgeon.

Preoperative cut-off values for body mass index deny patients clinically significant improvements in patient-reported outcomes after total hip arthroplasty.

Thresholds for operative eligibility based on body mass index (BMI) alone may restrict patient access to the benefits of arthroplasty. The purpose of this study was to evaluate the relationship between BMI and improvements in patient-reported outcome measures (PROMs), and to determine how many patients would have been denied improvements in PROMs if BMI cut-offs were to be implemented. A prospective cohort of 3,449 primary total hip arthroplasties (THAs) performed between 2015 and 2018 were analyzed. The following one-year PROMs were evaluated: hip injury and osteoarthritis outcome score (HOOS) pain, HOOS Physical Function Shortform (PS), University of California, Los Angeles (UCLA) activity, Veterans Rand-12 Physical Component Score (VR-12 PCS), and VR-12 Mental Component Score (VR-12 MCS). Positive predictive values for failure to improve and the number of patients denied surgery in order to avoid a failed improvement were calculated for each PROM at different BMI cut-offs. There was a trend to improved outcomes in terms of pain and function improvements with higher BMI. Patients with BMI ≥ 40 kg/m2 had median (Q1, Q3) HOOS pain improvements of 58 points (interquartile range (IQR) 41 to 70) and those with BMI 35 to 40 kg/m2 had median improvements of 55 (IQR 40 to 68). With a BMI cut-off of 30 kg/m2, 21 patients would have been denied a meaningful improvement in HOOS pain score in order to avoid one failed improvement. At a 35 kg/m2 cut-off, 18 patients would be denied improvement, at a 40 kg/m2 cut-off 21 patients would be denied improvement, and at a 45 kg/m2 cut-off 21 patients would be denied improvement. Similar findings were observed for HOOS-PS, UCLA, and VR-12 scores. Patients with higher BMIs show greater improvements in PROMs. Using BMI alone to determine eligibility criteria did not improve the rate of clinically meaningful improvements. BMI thresholds prevent patients who may benefit the most from surgery from undergoing THA. Surgeons should consider PROMs improvements in determining eligibility for THA while balancing traditional metrics of preoperative risk stratification. Cite this article: Bone Joint J 2020;102-B(6):683-692.

Comparison of prolene and progrip meshes in inguinal hernia repair in terms of post-operative pain, limitation of movement and quality of life.

The study aimed to compare the techniques applying prolene mesh and progrip-self fixating mesh in terms of post-operative pain, limitation of movement and quality of life. The study was conducted from November 2014 to January 2016 in Department of Surgery, Manisa Celal Bayar University Hospital. The study recruited 50 male patients, aged 18 and over and was carried out as a double blinded procedure. Twenty-five patients were randomly selected to receive hernia repair by progrip self-fixating mesh and 25 patients were treated with hernia repair with suture fixation method by using prolene grafts, and patients' pain follow-up was performed with face-to-face or telephone interviews with VAS (Visual Analogue Scale) and return to daily routine activities were evaluated with SF-36 (Short Form-36) quality of life scale. Recurrent hernias and emergency cases were excluded. The pain scores were lower and a statistically significant difference was achieved in patients in whom progrip self-fixating mesh was used in the early postoperative period. Both methods gave statistically similar results in terms of pain and quality of life. In the literature, there are some evidence that the repair applied with progrip self-fixating graft has more positive outcomes compared to the repairs applied with suture fixation. It is concluded that there is a need for longer follow-ups and larger series of cases in order to achieve a definite result.

Dynavisc as an Adhesion Barrier in Finger Phalangeal Plate Fixation—a Prospective Case Series of 8 Patients

PurposeAdhesion problems are common after plate fixation of finger phalanges and often lead to stiffness and reoperations with plate removal and tenolysis. The aim of this prospective case series was to study the effect of the adhesion barrier gel Dynavisc on total active motion (TAM), postoperative pain, and grip strength after plate fixation of phalangeal fractures. Total active motion at 3 months after surgery was the primary outcome.MethodsEight patients with a fracture of the proximal phalanx underwent surgery with open reduction and plate fixation. The adhesion barrier Dynavisc was applied between plate and extensor tendon and between tendon and skin. Results in terms of pain, grip strength, and TAM at 2 weeks, 3 months, and 1 year after surgery were collected. Results on TAM were classified according to Page and Stern.ResultsAfter 3 months, only 2 patients had a result classified as excellent. After 1 year, 3 patients fulfilled the criteria for an excellent result. There were no adverse events. Patients with long-standing postoperative pain had a worse outcome on TAM.ConclusionsThe antiadhesive effect of Dynavisc in this prospective case series was unconvincing. Only 2 patients had an excellent result on TAM at 3 months. Because the gel is resorbed within 30 days after application, it is questionable whether the gel had a role in improvement that occurred later in the postoperative course. Larger, randomized studies would be required to show any anti-adherent effect of Dynavisc definitively in finger fracture surgery.Type of study/level of evidenceTherapeutic IV.

Arthroscopic-assisted 6U approach for foveal reattachment of triangular fibrocartilage complex with an anchor: Clinical and radiographic outcomes at 4 years’ mean follow-up

The main objective of this study was to evaluate the long-term clinical and radiological outcomes of arthroscopic-assisted foveal repair of proximal triangular fibrocartilage complex (TFCC) tears with an anchor. The secondary objective was to look for ligament damage associated with TFCC tears. Twenty-four patients who underwent foveal repair of the TFCC were evaluated retrospectively: 16 stage 2 and 8 stage 3 in the Atzei-EWAS classification. The TFCC was repaired with an anchor using an expanded 6U approach. Systematic testing of intrinsic and extrinsic ligaments was performed. The assessment criteria were pain on a visual analog scale (VAS), wrist joint range of motion, grip strength and pronation-supination strength, and the QuickDASH and PRWE outcome scores. X-rays were also taken to assess anchor position and to look for distal radioulnar (DRU) joint damage. The average follow-up was 44 months. After the surgical repair, pain was reduced (7.36±1.3 preoperatively vs. 0.69±1.3 postoperatively; P<0.001), the QuickDASH score improved (52.1±16 vs. 21.7±7; P<0.001), the PRWE score improved (83.7±35 vs. 9.3±12; P<0.001) as did strength (35 vs. 43kg; P<0.001). The DRU joint stability was also significantly improved. The time away from work was 2.6 months. During the arthroscopy exploration, 25% of patients had an ulnotriquetral ligament lesion and 8% had an ulnolunar ligament lesion in combination with their TFCC tear. Fifteen anchors were positioned in the anatomical fovea (62%). No DRU joint damage was noted. Six patients had neurapraxia of the dorsal branch of the ulnar nerve, although it recovered spontaneously. One patient still had hypoesthesia of the ulnar side of the fifth finger at 48 months. Arthroscopic-assisted foveal repair of the TFCC yields good results in terms of pain, strength and DRU joint stability. In one-quarter of cases, TFCC foveal tears are associated with lesions of the ulnotriquetral ligament. There is no long-term degeneration of the DRU joint.