Orthopaedic Outpatient Department Research Articles

The role of tibialis posterior tendon transfer in foot drop by circumtibial route and evaluation of the results according to criteria

Background: The transfer of the tibialis posterior tendon to the anterior aspect of the ankle not only replaces the function of the paralyzed muscles, but also removes the deforming force on the medial aspect of the foot. This study was conducted to find the role of tibialis posterior tendon transfer in foot drop by circumtibial route and with evaluation of the results according to criteria.Methods: This study was conducted in MLB Medical College and Hospital, Jhansi. Patients of paralytic foot drop due to leprosy with a moderately strong tibialis posterior muscle were selected from the outpatient department of Orthopaedics and Leprosy reconstructive surgery units. After taking informed consent, detailed history was taken. Data was analyzed using Microsoft Excel and the difference was considered to be significant if ‘p’ value was <0.05.Results: Eleven patients were operated. Majority were males (82%). Eight patients (73%) had excellent and good results which were aged less than forty years. Two cases showed excellent results after corrective surgery that had deformities from 31 to 36 months before operation. Out of six patients who were taking antileprotic treatment, one (9.1%) showed excellent and three (27.3%) showed good results.Conclusions: Method of anterior transfer of tibialis posterior for correction of foot drop has given encouraging results in a fairly large percentage of cases. The greatest utility of such a transfer is that of allowing the freedom of normal mobility in comparison to bony stabilization. After correction of deformity and disability the patient’s mental health is improved.

The Association Between Symptoms of Depression and Office Visits in Patients With Nontraumatic Upper-Extremity Illness

Because psychological and social factors increase symptoms and limitations, it is possible that they are also related to higher use of care. We used a database of an academic outpatient orthopedic department in which patient-reported outcome measures were routinely collected and identified 3,620 patients with de Quervain tendinopathy, ganglion, trapeziometacarpal arthritis, trigger digit, or carpal tunnel syndrome who remained in care at least 3 months. At every office visit, patients completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Computerized Adaptive Test (CAT), PROMIS Pain Interference CAT, and PROMIS Depression CAT. We conducted multivariable Poisson regression analysis of factors associated with the total number of office visits, accounting for PROMIS scores at the first office visit, age, surgical treatment, sex, diagnosis, and clinician team. Operative treatment had the greatest influence on the number of office visits. Other variables associated with the number of visits were female sex, younger age, higher PROMIS Depression scores, and higher Pain Interference scores. Treatment choice had the greatest influence on the number of subsequent visits for atraumatic conditions. The fact that the total number of office visits is associated with greater symptoms of depression and greater pain interference, independent of treatment choice, suggests a relation between mental health and resource use. Quality improvement efforts and future research might address whether adding strategies to decrease symptoms of depression and optimize coping strategies (to reduce pain interference) might improve upper-extremity health more efficiently than standard treatment alone.

Mechanical loading mediates human nucleus pulposus cell viability and extracellular matrix metabolism by activating of NF-κB.

Lower back pain is one of the most frequent complaints in US orthopedic outpatient departments. Intervertebral disc degeneration (IDD) is an important cause of lower back pain. Previous studies have found that mechanical loading was associated with IDD, but the underlying mechanism remains unclear. In the present study, a human nucleus pulposus cell line was used to establish an in vitro mechanical loading model. Mechanical loading, western blot analysis, quantitative PCR, ELISA, cell viability assay and IHC staining were used in the current study. It was found that a short loading time of 4 h followed by a long period of rest (20 h) exerted protective effects against matrix degradation in nucleus pulposus cells, whilst a longer loading time of 20 h followed by a shorter period of rest (4 h) resulted in cell apoptosis and extracellular matrix (ECM) degradation. Excessive mechanical loading may induce ECM degradation by activation of the NF-κB signaling pathway. Taken together, these findings demonstrated that whilst moderate mechanical loading exerted beneficial effects on nucleus pulposus cells, excessive mechanical loading inhibited human nucleus pulposus cell viability and promoted ECM degradation by activating NF-κB.

Clinical profile of patients with clavicle fracture

Fracture clavicles are known since ancient time, earliest description of fracture clavicle is found in Egyptian literature in 3550 BC. The clavicle is the only long bone in the body that lies horizontally. Medially, it articulates with the sternum at the sterno-clavicular joint. At its lateral end it articulates with the acromion, at the acromioclavicular joint. The study was conducted on 62 patients with fracture of clavicle, attending Emergency and Outpatient Department of Orthopedics, Medical College and Hospital. Patients were clinically examined; first aid was given in the form of, cuff and color sling, analgesics, antacids and was subjected to A-P view, Lardotic view radiograph of full length clavicle to decide the plan of definitive management. If needed CT scan and MRI were also taken. In our study out of 62 patients 42 (67.74%) patients sustained trauma due to road traffic accident, 15 (24.19%) patients fall from height and 5 (8.06%) patients from assault. Thus commonest (67.74%) mode of trauma was road traffic accident. Fractures of middle third of clavicle only were included in the study and medial end and lateral end were excluded as per our criteria. None of the patient had bilateral involvement.

Effects of intra articular steroids, hyaluronic acid and combination of both among patients with knee osteoarthritis

<p class="abstract"><strong>Background:</strong> Osteoarthritis (OA) is a common degenerative disorder of articular cartilage accompanied by hypertrophic changes of the bone. In the management of OA, though use of intra articular (IA) injection of steroids, hyaluronic acid (HA) separately plays an important role, their effects in terms of reducing pain, joint stiffness and movement restriction when it is used in combination remains a question. Hence this study was planned to assess the effects of HA and steroids alone with combination of both Ha and steroids.</p><p class="abstract"><strong>Methods:</strong> Prospective randomized comparative study, among patients with osteoarthritis knee attending the outpatient department of Orthopedics in a tertiary care hospital during January 2017 to May 2018, were included. Patients were randomized in three groups (steroids, HA and combination of both) and a total of 96 patients were included and the outcome was assessed by WOMAC scale. Statistical analysis was done using SPSS Version 20.<strong></strong></p><p class="abstract"><strong>Results:</strong> Pain and movement restriction, at the end of fourth week and pain, joint stiffness and movement restriction, were found to be statistically improved in combined steroids and HA group than the group with steroids alone. Similarly at the end of third month, pain and movement restriction were found to be statistically improved in combined steroids and HA group than HA group alone.</p><p class="abstract"><strong>Conclusions:</strong> This study demonstrates that HA together with corticosteroid provides pain relief, reduction of joint stiffness and helps in improving joint movements within three months after treatment.</p>

Impact of Vitamin D repletion on treatment of chronic lower back pain

Background: Chronic lower back pain is precisely a distressing condition not only because of associated physical debilitation but the psychological hassle as well. Along with various etiological factors, low vitamin D levels in the body is also a significant cause of this ailment. This study focuses on monitoring the effect of Vitamin D repletion on intensity of chronic (non-traumatic) lower back pain.
 Methodology: This longitudinal-prospective analysis was conducted upon a sample of 374 lower back pain patients presenting with vitamin D deficiency from February to October 2018. Inquiries were made regarding basic socio-demographics, history of chronic lower back pain, dietary and medicinal supplement usage, hours of sun exposure and pain levels, assessed using a Visual Analogue Scale (VAS). The vitamin D levels and the VAS pain score were assessed upon baseline visit to the orthopedic out-patient department and followed up after 2 months (1st follow up visit) and 6 months (2nd follow up visit). Data obtained was analyzed using SPSS version 21.0 and Microsoft Excel 2013.
 Results: Among the 374 respondents, 52.67% were males while 47.33% were females with the mean age of 47.5 years. The mean baseline (pre-intervention) vitamin D levels were found to be 10.3 ng/ml, which raised significantly to 34.3 ng/ml. The mean (pre-intervention) VAS score dropped significantly, from 81.9 at baseline visit to 31.4 at 2nd follow up visit.
 Conclusion: It is concluded that vitamin D repletion has a marked impact on reducing the intensity of chronic lower back pain. Future studies may confirm further to validate the findings of this research.

Frequency of orthopedic problems among patients attending an orthopedic outpatient department: a retrospective analysis of 23 495 cases.

ABSTRACTBACKGROUND: Baseline statistical data on the current orthopedic outpatient load was needed to highlight the more frequent orthopedic problems.OBJECTIVE: Describe the frequency of orthopedic problems among patients attending the orthopedic outpatient department (OPD).DESIGN: Descriptive, retrospective medical record review.SETTINGS: Four-year data (2013-2017) was extracted from the computer records of patients attending the orthopedics OPD.PATIENTS AND METHODS: Computer entries of OPD visits were found, and after excluding incomplete and follow up data, age, gender, and diagnoses were described.MAIN OUTCOME MEASURES: Frequency of orthopedic diagnoses.SAMPLE SIZE AND CHARACTERISTICS: 23 495 patients, 19 377 (82.5%) males and 4118 (17.5%) females, majority (18 155, 77.3%) 19–50 years of age.RESULTS: Lower back pain (26%), tendinopathies and enthesopathies (18.3%), and bone fractures (11%) were the three common problems followed by arthritis (10.6%), nonspecific body ache (7.4%), and soft tissue injuries (9.9%). Others prominent diagnoses were ligamentous sprains (6.4%), neck-related problems (4.8%), joint stiffness (1.8%) and sports injuries (1%).CONCLUSION: This overview of the orthopedic problems in a secondary care hospital may aid in the formulation of better protocols and strategies to manage orthopedic disorders in a healthcare setting.LIMITATIONS: Retrospective and only included the primary diagnosis.CONFLICT OF INTEREST: None.

Case report: migration of a broken screw to the knee joint after hardware failure following closing wedge distal femoral osteotomy

BackgroundWe report a case of hardware failure after distal femoral osteotomy (DFO) with a broken screw pulled out from the locking hole and positioned within the knee joint.Case presentationA 57-year-old man presented to our orthopedic outpatient department with 3-months history of an unusual painful swelling at the operated area following DFO. The leakage of joint fluid from the penetrated suprapatellar pouch was assumed to be the reason for this complication.ConclusionsThe overall aim of this case report is to provide a lesson to budding surgeons who might experience a similar situation that cannot be easily explained, like the unexpected complication in the present case.

DEMOGRAPHIC AND ETIOLOGIC INVESTIGATION OF GOUT ARTHRITIS CASES IN THE KARS REGION, A COMPARATIVE RETROSPECTIVE STUDY

Introduction: Gout arthritis is a very common rheumatic disorder. The hyperuricemia develops due to increased serum uric acid synthesis and/or decreased renal excretion.
 Material and Method: This study was conducted after permission was obtained from the Kafkas University Ethics Committee (KAU-26-06-2018-09). We included patients who presented to the Kars Harakani State Hospital and the Kafkas University Faculty of Medicine Orthopedics and Traumatology outpatient department between May 2012 and December 2018 and were diagnosed with gout arthritis into the study. The patients were divided into two groups as Group I (n:87) consisting of patients who received Allopurinol (Xanthine Oxidase Inhibitor) at a dose of 100 mg 1x1 po for 4 weeks together with a purine-poor diet (provided as a list) and Group II (n:77) consisting of patients recommended abundant water consumption (2 lt/day), decreased tea consumption, increased milk and dairy products consumption and a purine-poor diet (given as a list) without the administration of any drugs. Both groups were called 4 weeks later for clinical follow-up and they underwent a physical examination and laboratory evaluations at the outpatient department. Treatment protocols were evaluated comparatively according to the uric acid levels and physical examination findings.
 RESULTS: Group I received a xanthine oxidase inhibitor + purine-poor diet and consisted of 5 female and 19 male patients aged 18-60 years and 17 female and 46 male patients aged 60 and over. Group II received optimal Hydration + milk and dairy products + purine-poor diet and consisted of 24 females and 53 males aged 60 and over without any patients in the 18-60 years age group. Pretreatment uric acid levels and posttreatment 4th week uric acid levels were compared.
 CONCLUSION: In addition to gout arthritis treatment with drugs, it is possible to treat these patients without giving any drugs by increasing the consumption of milk and dairy products together with optimal hydration.
 Key Words: Gout arthritis, Xanthine oxidase inhibitor, optimal hydration, Milk

EFFICACY AND TOLERABILITY OF FLUPIRTINE VERSUS TRAMADOL IN THE TREATMENT OF MODERATE CHRONIC LOW BACK PAIN

Objective: The objective of the study was to assess and compare the efficacy and tolerability of flupirtine versus tramadol in patients with chronic moderate low back pain (LBP).
 Materials and Methods: A prospective study was conducted in the outpatient department of orthopaedics at tertiary care hospital, Rajamahendravarm. After meeting the inclusion criteria, a total of 60 patients were randomly allocated to tablet flupirtine 100 mg in Group A and tablet tramadol 50 mg in Group B. The efficacy of the study drugs was assessed at baseline and the end of treatment by numerical rating scale11, visual analog scale-100 mm, physician’s, and patient’s global assessment. Statistical analysis was done using paired and unpaired t-test and data were presented as mean±standard deviation. Adverse drug reactions were monitored during the treatment.
 Results: The study results showed that 90% of the patients in Group A and 78% of the patients in Group B had shown a good response to their respective drugs. 30% of flupirtine group patients reported adverse drug reactions which were mild.
 Conclusion: Both the drugs are effective in the treatment of moderate chronic LBP, but the advantage of flupirtine was, the incidence of adverse drug reactions was less when compared to tramadol group.

Prescription Audit, Drug Utilization Pattern and Adverse Drug Reaction Monitoring in Outpatients of Orthopedics Department of Tertiary Care Teaching Hospital: A Pilot Study

Background: The domain of orthopedic illnesses is grossly underrepresented in the current healthcare scenario especially due to overreliance on mortality rather than the morbidity or dysfunction. Continuous introduction of new drugs in the field of pharmacology requires holistic utilization, effectiveness, and side-effects studies. In addition, inappropriate use of drugs poses a risk of adverse drug reactions (ADRs). Our study aims to analyze the prescription pattern in outpatient department of orthopedics at a tertiary care hospital of Delhi. Methodology: The study was carried out in 210 patients who attended the orthopedics outpatient department for a period of 3 months. Patient demographic details, duration of illness, comorbid conditions, drugs prescribed, ADRs, and usage of complementary and alternative medicine were used to analyze the pattern of drug use. Results: In our study, we observed that vitamins and mineral preparations (20%) was the most commonly prescribed class of drugs followed by nonsteroidal antiinflammatory drugs (11.42%). Polypharmacy was seen in most of the prescriptions (60.95%), but 100% of the drugs were from Essential Medicine List of Government of National Capital Territory, Delhi. About 75% of the prescriptions were prescribed by generic names. ADRs were reported in 30 patients and majority of them were mild in nature (96%). Complementary and alternative medicine was used by 13.3% of the study patients. Conclusion: Majority of the drugs were prescribed by generic names and were essential medicines. Trend of polypharmacy was noted. Injudicious use of multivitamins and calcium was seen. Nonsteroidal antiinflammatory drugs were a significant part of therapy. ADRs reported were generally mild in severity and involved gastrointestinal tract. Need of the hour is to conduct frequent prescription audits to inculcate good prescribing practices.

Comparing efficacy and tolerability of eperisone with thiocolchicoside in the management of non-specific low back pain

Background: Low back pain (LBP) afflicts 60–80% of the people worldwide at some point in their lifetime. Association of spinal muscle spasm justifies centrally acting muscle relaxants in the treatment. Controversial superiority of eperisone visa-vis thiocolchicoside was instrumental to inception of this research. Aims and Objectives: This study aims to compare the efficacy and safety of eperisone with thiocolchicoside in treatment of non-specific LBP. Materials and Methods: This follow-up study was done in C. R. G. Hospital, Ujjain (India). Eligible 215 patients, of either sex, between 18 and 60 years from the outpatient orthopedic department were included and dysfunctional status was quantified by modified Oswestry Disability Index. The patients were given eperisone hydrochloride 100 mg 3 times daily or thiocolchicoside 8 mg twice daily. The analgesic activity and adverse drug reactions were evaluated on the follow-up visit after 7 days of treatment against the baseline. Results: Of 196 patients who completed the study, females were more (119; 60.71%) than the male (77; 39.28%). “Mean score ± standard deviation” of disability decreased from 26.13 ± 8.28 at baseline to 11.47 ± 4.86 in eperisone group and from 24.78 ± 7.24 at baseline to 9.92 ± 3.63 in thiocolchicoside group. Change in the score against the baseline was statistically significant (P < 0.05) in both the groups but insignificant across the groups. Adverse events experienced were less with eperisone. Conclusion: Compared to thiocolchicoside, eperisone hydrochloride is equipotent but better tolerated option in LBP.

A prospective study of surgical management of chronic neglected tendoachilles rupture with teuffer technique

Aim: Injuries of Achilles tendon are relatively common in middle aged athletes and it's one of the most common tendons to be ruptured. As Achilles tendon rupture is both a serious injury and one of the most common tendinous lesions, various treatment modalities are devised. We conducted a prospective study to analyze outcome of surgical management of chronic neglected tendoachilles rupture with Teuffer technique. Materials and Methods: Our study included 20 patients of chronic neglected tendoachilles rupture. Those who visited VIMS orthopedic outpatient department were examined and included in our study once they satisfied the inclusion criteria and after thorough preoperative analysis patients were operated under spinal anaesthesia with Teuffer’s technique. Post operatively patients were put on pop slab and progressive strengthening and rehabilitation program was followed. Patients were followed up at 4 weeks, 8 weeks, 3 months and at 6 months and final outcomes were measured using modified Rupp scoring. Results: Final outcome were measured using modified Rupp scoring which showed 10 excellent, 4 good, 4 fair and 2 poor results. Conclusion: Results of reconstruction of chronic Achilles tendon ruptures using Teuffer’s technique showed the technique to be, a strong and stable repair that allows early weight bearing and ambulation, with favorable clinical results, in most patients.

Functional Ultrasonography in Diagnosing Anterior Cruciate Ligament Injury as Compared to Magnetic Resonance Imaging.

Background:Magnetic resonance imaging (MRI) has been gold standard investigation for diagnosing anterior cruciate ligament (ACL) tear. Availability and cost are two main factors limiting the universal use of MRI in all those patients in whom ligament injury is suspected. We compared the outcome of functional USG with gold standard MRI scan in this prospective study.Materials and Methods:In this study, we included the patients coming to orthopedics outpatient department with sign and symptoms of ACL injury. We performed functional USG of the injured and uninjured knee and noted the difference in translation, measured by USG. More than 1 mm of difference in translation of tibia on the affected side as compared to uninjured side is taken as significant. We compared our result with the findings of MRI. The study result of 130 patients revealed high sensitivity (81.65%) and high specificity (89%) in diagnosing ACL injury. The positive predictive value of the test was 97.8%, and the negative predictive value was 44%. The P value of the difference of translation as 0.0001 was also statistically significant.Conclusions:We can safely conclude from the study that the functional USG can be used as a primary tool to diagnose ACL tears. USG's ubiquitous availability and simple technique of the procedure can bring a revolution in the future for diagnosing and managing ACL injury.

A hospital based cross sectional study on synovial fluid analysis among patients with different types of knee joint disorders at a tertiary care hospital

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Patients presenting with knee joint disorders are subjected to variety of investigations which are often inconclusive. Instead if they are subjected for synovial fluid analysis, they will be benefited. The objective of the study was to study synovial fluid analysis among patients with different types of knee joint disorders at a tertiary care hospital.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A hospital based cross sectional study was carried out among 30 patients attending the outpatient Department of Orthopedics and suffering from knee joint pain of either left or right or both the sides. Present study was carried out over a period of two years from January 2011 to December 2012 at Department of Orthopedics, Global Hospitals, Secunderabad. All patients were examined in detail and subjected to all necessary investigations.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Males were more than females. The most common joint disease in the study population was tubercular synovitis in 20% of the cases. The most common condition among males was osteoarthritis while there was no such case in females. Rheumatoid arthritis was most common in females while there was no such case in males. Polymorphs were seen in all cases except osteoarthritis and villonodular synovitis. On biochemical analysis of synovial fluid it was found that gouty arthritis did not have proteins. Proteins were minimum in the synovial fluid in case of osteoarthritis while maximum range was found in cases of tubercular arthritis and rheumatoid arthritis.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Synovial fluid analysis is very important to understand the etiopathogenesis of knee joint diseases. Our study showed that synovial fluid of the knee joint analysis was very informative in the diagnosis and proper management of the patients presenting with knee joint disorders.&lt;/p&gt;

A comparative study of efficacy and safety of glucosamine plus chondroitin sulphate versus rosehip as add on therapy to NSAIDs in patients suffering from osteoarthritis

Background: Osteoarthritis is a chronic and debilitating disease. Management of disease is a big challenge. NSAIDS play an important role but have many adverse reactions. So, this study was designed to evaluate the efficacy and safety of natural compound rosehip versus glucosamine and chondroitin sulphate in patients of osteoarthritis.Methods: An open label, randomized, parallel group comparative study, conducted on patients of either sex with confirmed diagnosis of osteoarthritis on standard NSAIDs therapy, attending the outpatient department of orthopedics in a tertiary care centre. 150 patients were enrolled and divided into three groups (group A, group B and group C) of 50 each. Patients of group A were given Glucosamine plus chondroitin sulphate for 12 weeks. Group B was given rosehip for 12 weeks and group C placebo. These supplements were given as add on therapy. Patients were monitored and adverse drug reactions were noted. The data was analysed statistically using t- test for efficacy and descriptive stats for assessing the safety.Results: Efficacy was assessed by comparing mean reduction in the pain intensity between group A and B, group B gives highly significant results as compared to group A. While comparing joint tenderness, swelling around joint, mean functional capacity and improvement in the overall assessment, group B gives significant results as compared to group A. It was also observed that group A and group B were better than group C in all the efficacy parameters. All the drugs were well tolerated and systemically safe.Conclusions: There was significant difference in efficacy of rosehip compared with glaucosamine and chondroitin sulphate in patients of osteoarthritis. In comparison there was no significant difference in safety of two drugs and both were considered safe in patients.

Dervan dermatome syndrome often missed but surprisingly common coexistent spine pathology in ‘Knee Pain’, ignore at your own risk

Introduction: Knee pain is among the commonest complaints in the outpatient orthopedic department. However the cause does not always originate from knee itself. and knee pain is used by the patient more as an umbrella term. In fact very few patients give the complete list of accompanying symptoms. They have more often than not to be coaxed out of the patient. To make matters more complex, Referred pain from the Spinal nerves, Hip and Ankle joints join the many structures around the knee to make knee pain an umbrella term for this Pandora’s Box. Misdiagnosis or partial diagnosis leads to inadequate or wrong treatment and continued suffering for patient and treating doctorsMaterials & Methods: 78 patients with knee pain attended the OPD of Walawalkar hospital, Dervan. On x-ray, 28 were found to have different grades of osteoarthritis. Of these 25 agreed to be part of this pilot study. They underwent standing x rays & MRI of the lumbosacral spine.Results: This study found an unusually high rate of coexistent knee and spine pathologies. All patients had some degree of disc disease accompanying medial or tricompartmental osteoarthritis. It undermines the need for investigating this important contributor to the umbrella term of knee pain.The commonest affected disc segment was L4-5 i.e 92% with two patients having L5- S1 prolapse 8%. The purpose of this pilot study is only to alert the surgical and rehabilitation colleagues of the frequent coexistence of the spine and knee conditions for Counseling, consent, surgery & rehabilitation and thus improve patient satisfaction.

A case series studying the effect of low level laser therapy in osteoarthritis knee in elderly population of northeastern India

Background: Osteoarthritis knee affects a large portion of the population and it is the leading cause of disability worldwide. The increase in life expectancy further added to the burden of the disease. Joint replacement surgery is in accessible to most people in this region. Our objective is to study the effectiveness of low level laser therapy in primary osteoarthritis knees in the north-eastern elderly population of India. Materials and methods: This is a prospective cohort study in 30 patients attending orthopaedic outpatient department with primary osteoarthritis knee. All selected patients including both male and female were managed with low level laser therapy (wavelength of 905 nm and a power that varies from 27 Wp to 100 Wp) for 4consecutive weeks. Scoring using WOMAC (Western Ontario and McMaster University Osteoarthritis Index) and VAS (Visual analog scale) were taken during first enrolment and then at 4 and 8 weeks of follow up. Results: There was a significant improvement in both WOMAC and VAS scores both at 4 weeks and 8 weeks of follow up. Improvement from baseline WOMAC mean score (enrolment 58.8, 79.36 at 4 weeks and 93.1 at 8 weeks (p

A prospective study for definitive diagnosis of various arthropathies by synovial fluid analysis and percutaneous needle biopsy of synovium

Objectives: To evolve a diagnostic pattern of synovial fluid analysis, thus determining the usefulness of routine synovial fluid analysis as a simple diagnostic aid in various forms of arthritis. Background: Synovial fluid analysis is a simple, inexpensive investigation, whereby, based on simple laboratory tests and the physical characteristics of the synovial fluid, definitive diagnosis of various arthritis could be arrived at. Synovial fluid aspiration is a simple OPD procedure. It does not need much expertise. It could be performed in all hospitals including the primary health centre. Methods: 50 patients with joint effusion attending the orthopaedic outpatient department of our hospital, were selected at random. They were examined clinically, subjected to routine laboratory investigations, radiology and then synovial fluid aspiration was done under aseptic precautions and sent to biochemistry, pathology and microbiology departments for synovial fluid analysis. Doubtful cases based on synovial fluid analysis reports, were subjected to histopathological examination. Results: Out of the 50 cases, 13 cases were diagnosed as osteoarthritis, 12 as traumatic arthritis/ haemarthrosis, 6 patients were diagnosed as tuberculous arthritis, 5 as septic arthritis and 5 patients as rheumatoid arthritis. One case each was diagnosed as gouty arthritis and neuropathic joint effusion. 7 cases were diagnosed as chronic non-specific synovitis as no definitive diagnosis could be arrived at, after interpreting the synovial fluid analysis findings and histopathological examination. Interpretation and Conclusion: Synovial fluid analysis is a satisfactory procedure in terms of both diagnosis as well as patient’s compliance point of view, especially in a patient of rural area and lower socio-economic strata. Diagnosis of various arthropathies can be obtained and obtained early in a significant number of cases. The technique can eliminate unnecessary treatment and possibly, the need for an arthrotomy.

Evaluation the pattern of adverse drug reactions by non-steroidal anti-inflammatory drugs at the outpatient orthopedics department of a university teaching hospital in north India

Background: The study was conducted with an aim to evaluate the pattern of occurrence of adverse drug reactions (ADRs) of Non-steroidal anti-inflammatory drugs (NSAIDs) in orthopedic patients in a tertiary care teaching hospital of North India.Methods: An observational study was carried out in the orthopedic outpatient department at the tertiary care hospital for the period of six months. All patients diagnosed with acute pain and receiving NSAIDs were included. The documented ADRs were assessed for causality, severity and preventability using Naranjo’s algorithm and WHO-UMC scale, modified Hartwig and Seigel Scale and modified Schumock and Thornton scale, respectively.Results: A total of 84 ADRs were reported from 51 patients. The most common ADRs observed were from gastrointestinal (38%) followed by skin (18%) and autonomic nervous system (12%). Maximum number of ADRs were reported in patients on diclofenac (47%) followed by piroxicam (44%). Upon causality assessment, majority of the reactions were possible (61.5% with WHO-UMC scale, and 57.1% with Naranjo’s algorithm). The association of results between the two scales was statistically significant (p&lt;0.001). Majority of ADRs (73.4%) were assessed as mild and 66.7% of the ADRs were probably preventable.Conclusions: Authors conclude that incidence of ADRs can be decreased and compliance can be improved by early detection and management.