Terms Of Functional Outcomes Research Articles

The Clinical Impact of Physical Activity on the Diagnosis of Prostate Cancer and Postprostatectomy Functional Outcomes in the Elderly.

The effect of physical activity on prostate cancer is controversial. We aimed to investigate the effect of physical activity on prostate cancer detection and functional outcomes after radical prostatectomy. Between 2019 and 2020, 166 patients who underwent prostate biopsy were included. The physical activity scores of patients were evaluated by the Physical Activity Scale for the Elderly (PASE) questionnaire before the procedure. PASE scores were compared between the patients with and without prostate cancer and local and metastatic aggressiveness of cancer. Patients who underwent radical prostatectomy were followed up for 12 months to analyze the effect of physical activity on erectile dysfunction (ED) and urinary incontinence (UI). There was no significant difference between patients with and without prostate cancer in terms of PASE scores (187.7 vs. 195.5, p=0.665). PASE scores were also similar when separated according to D'Amico risk classification and metastatic events. Twenty-seven patients who underwent radical prostatectomy were evaluated in terms of functional outcomes at the first year of surgery. PASE scores of the patients with severe ED were lower than mild-moderate ED, but no statistically significant difference was observed (197.0 vs. 268.5, p=0.267). Patients with persistent UI had a significantly lower PASE score overall than continent patients (128.3 vs. 271.1, p=0.001), and PASE score was the only independent predictor of UI following radical prostatectomy. The effect of physical activity on prostate cancer development or aggressiveness could not be determined. Physical activity was associated with a reduced risk of UI following radical prostatectomy.

EFFICACY AND SAFETY OF KNOTLESS BARBED SUTURES IN CAPSULAR CLOSURE FOLLOWING DISTAL FEMUR FRACTURE FIXATION.

Good wound closure is an important step in management of distal femur fracture to prevent infection and faster rehabilitation. Knotless barbed sutures can save time and distribute wound tension evenly. However, its role in terms of functional outcome, closure time, and postoperative complications has not been studied in a distal femur fracture. A total of 47 patients aged more than 18 years of distal femur fracture treated with distal femur locking plate were randomized either into either barbed or traditional suture groups. in the barbed group, capsular wound closure was carried out with 2-0 bidirectional barbed knotless sutures (Quill SRS® PDO, Angiotech, Vancouver, BC, Canada). In patients assigned to group B, capsular closure was done with 1-0 Vicryl® (Ethicon inc. Somerville, NJ) and 5-0 Ethibond® alternatively. The mean flexion at the knee joint was 105.7±15.6 degrees in the study group while it was 110.4±13.7 in the control group (p= 0.2133). Mean estimated closure time was significantly shorter in the study group as compared to the control group (p<0.05). Cases of needle prick injury were higher in traditional suture group. Patients developed stitch abscess and superficial infection in both groups. However, the difference in incidence between the two was not statistically significant. Barbed suture is an efficient method of wound closure. It reduces wound closure time with similar complication rate as with use of conventional sutures. Evidence Level II; Randomized Clinical Trial.

Cost-effectiveness analysis of endovascular treatment with or without intravenous thrombolysis in acute ischemic stroke.

Intravenous (IV) recombinant tissue plasminogen activator (r-tPA) may not provide additional benefit in terms of functional outcomes in patients with acute ischemic stroke (AIS) who undergo endovascular treatment (EVT). In this context, the cost-effectiveness of EVT alone compared with its application following IV r-tPA has not been evaluated. The authors determined the average rates of death or disability in each of the two treatment groups from four randomized clinical trials that enrolled patients with AIS within 4.5 hours of symptom onset and randomly assigned patients to EVT alone and IV r-tPA and EVT. By using three sources derived from previous studies, the authors determined the cost of IV r-tPA, cost of staff time for administration, cost of the EVT, cost of hospital stay, costs of supported discharge and community care, and cost of posthospitalization care and disability. They then assessed the cost-effectiveness of EVT alone using a decision tree for the 1st year after AIS and a Markov model with a 10-year horizon, including probabilistic assessment by Monte Carlo simulations. The 1-year cost was higher with IV r-tPA and EVT compared with EVT alone (incremental cost ranging between $3554 and $13,788 per patient). The mean incremental cost-effectiveness ratios (ICERs) were -$1589, -$78,327, and -$15,471 per quality-adjusted life-year gained for cost sources 1, 2, and 3, respectively, for EVT alone compared with IV r-tPA and EVT at 10 years. The ceiling ICER (willingness to pay) for a probability of 100% that EVT alone was more cost-effective ranged between $25,000 and $100,000 in the three models. EVT alone appears to be more cost-effective compared with EVT and IV r-tPA for the treatment of AIS patients presenting within 4.5 hours of symptom onset.

Functional outcomes of titanium elastic nail procedure after femoral shaft fracture in pediatric patients

Pediatric femur diaphyseal fractures are seen after serious traumas such as traffic accidents and fall from height. Although treatment algorithms are made according to age groups, treatment planning is individualized according to the patient and the degree of injury. In our study, we evaluated functional outcomes of pediatric femur fractures treated with titanium elastic nail (TEN). This is a retrospective study including pediatric femoral diaphyseal fractures treated with TEN between 2012 and 2021. Open fractures, pathological fractures, distal fractures involving the femoral condyles, and proximal fractures involving the trochanteric region were not included in our study. Thirty-three femoral diaphyseal fractures with complete data were identified as stable and unstable in length, and functional results and post-treatment complications were recorded by performing TEN in fracture fixation. Clinical functional results were analyzed with Flynn criteria. Thirty-three femoral fractures of 29 patients were included. Eighteen (62.1%) of our patients were boys and 11 (37.9%) were girls. The mean age was 6.51 years (4-13 years). The most common injury mechanism was traffic accidents seen in 19 patients (24.51%). The mean follow-up period after surgery was 26.6 (6-90 months) months. Stable fractures (transverse and short oblique) were found in 26 cases (78.7%) and unstable fractures (spiral/long oblique and comminuted) in 7 cases (21.7%). According to Flynn criteria, excellent results were found in 20 fractures (60.6%) and satisfactory results in 10 fractures (30.3%) and 3 poor (%9.09). There was no significant difference between stable and unstable fractures in terms of functional outcome (p=0.12). Femoral diaphyseal fractures are serious injuries that require surgery. Regardless of the type of fracture, stable or unstable in length, the results of treatment with TEN are very successful. Major complications such as nonunion and re-fracture are rarely seen with this treatment.

Functional outcome of long-arm cast versus double sugartong splint in acute paediatric distal forearm fractures: A randomised controlled trial

Background: The treatment of choice for paediatric distal forearm fractures has been a long-arm cast (LAC) following closed reduction. An alternative treatment is to use a double sugar-tong splint (DSTS), found equally effective to provide three-point fixation and comparable outcomes to cast. Objectives: To compare the functional outcome between LAC and DSTS for the treatment of paediatric distal forearm fractures. Methods: A randomised controlled trial was done among 36 patients of 5-15 years with acute distal forearm fractures without neurovascular deficit treated with LAC and DSTS recruited by convenience sampling at a tertiary care centre after ethical approval. Acceptability of reduction, loss of reduction, union rates, cast comfort, range of motion and complications were studied at follow-up upto 12 weeks and analysed using SPSS v.11.5. Results: Among a total of 36 patients, 18 cases were treated by the LAC method and others by the DSTS method. Both LAC and DSTS were comparable in the maintenance of reduction, the remanipulation rate was 8.3% (n = 3), not significant (p-value = 0.967). All had a union at six weeks follow-up. No statistical difference in mean VAS score (p-value = 0.524), mean loss of flexion (p-value = 0.397), and mean loss of pronation/supination (p-value = 0.814). No statistically significant difference in activities of daily living was noted. No complications were encountered. Conclusion: DSTS is safe and as effective as LAC in the treatment of distal forearm fractures in children, identical in terms of functional outcome, maintenance of reduction, complications, and time to union.

Impact of Cranioplasty on Rehabilitation Course of Patients with Traumatic or Hemorrhagic Brain Injury.

Some authors have hypothesized that cranioplasty after decompressive craniectomy (DC) could positively influence functional recovery through several mechanisms. However, only a few studies with small sample sizes have investigated the effects of cranioplasty on functional recovery. Our study aims at evaluating the role of post-DC cranioplasty in influencing the functional recovery in a large cohort of patients with different etiologies of acquired brain injury (ABI). This retrospective study consecutively enrolled 253 patients with ABI, consisting of 108 adults who underwent post-DC cranioplasty and 145 adults who did not. All the subjects underwent a 6-month individual rehabilitation program. Demographic data, etiology, classification and anatomical site of brain injury, neurological and functional assessment at baseline and on discharge, and number of deaths during hospitalization were recorded. In our cohort, 145 patients (57.3%) and 108 patients (42.7%) had, respectively, a hemorrhagic stroke (HS) and a traumatic brain injury (TBI). Only in the patients with TBI cranioplasty emerged as an independent predictor of better functional outcome in terms of the Functional Independence Measure (FIM) total score at discharge (β = 0.217, p = 0.001) and of the FIM variation during rehabilitation (ΔFIM) (β = 0.315, p = 0.001). Conversely, in the case of HS, no associations were found between post-DC cranioplasty and functional recovery. Post-DC cranioplasty was associated with better functional recovery six months after TBI but not in the patients with HS. Although the pathophysiological mechanisms underlying HS are different from those of TBI and possibly play a role in the different outcomes between the two groups, further studies are needed to investigate the mechanisms underlying the observed differences.

Predictors of Mortality and Functional Outcome in Pregnancy and Puerperium-Related Cerebral Venous Thrombosis

Introduction: Cerebral venous thrombosis (CVT) associated with pregnancy and puerperium has long been recognized, with poor information in terms of functional outcomes. Our objective was to analyze risk factors, clinical, imaging, and laboratory variables to predict functional outcome and death in this population. Methods: CVT registries from three referral centers from Pakistan, Turkey, and Mexico, recruiting prospective cases, were combined for CVT associated with pregnancy or puerperium. Datasets and variables were standardized. Demographic characteristics, presentation, risk factors, and functional outcomes in pregnancy/puerperium-related CVT were analyzed. Binary logistic regression was used to assess predictors of outcome. The main outcome was modified Rankin score >2 at 30 days and mortality at 30 days. Results: Five hundred fifty-three cases (median age 28 years [IQR 23–34]) of CVT associated with pregnancy and puerperium were included; 439 cases (79.4%) happened in the puerperium and 20.6% during pregnancy (53.5% occurred during the first trimester). Anemia (36.7%) and dehydration (22.9%) were the commonest obstetric risk factors identified. Predictors of poor outcome (mRS >2) were encephalopathy (OR 12.8, p < 0.001), cases from Mexican origin (OR 3.1, p = 0.004), fever/puerperal infection (OR 2.7, p = 0.02), and anemia (OR 2.2, p = 0.01). Cases from Mexican origin (OR 12.0, p = 0.003) and Encephalopathy (OR 7.7, p < 0.001), presented with the highest mortality association in the final adjusted model. Discussion/Conclusion: In CVT associated with pregnancy and puerperium, encephalopathy, fever/puerperal infection, and anemia are associated with bad functional outcomes, meanwhile encephalopathy and cases from Mexican origin with higher mortality in the acute (30-days) of CVT onset. Anemia and infection are potential reversible predictors of poor outcome that clinicians should be aware of in order to prevent poor outcomes in these patients.

Transcutaneous vagal nerve stimulation to treat disorders of consciousness: Protocol for a double-blind randomized controlled trial

BackgroundPatients with disorders of consciousness (DoC) are a challenging population prone to misdiagnosis with limited effective treatment options. Among neuromodulation techniques, transcutaneous auricular vagal nerve stimulation (taVNS) may act through a bottom-up manner to modulate thalamo-cortical connectivity and promote patients’ recovery. In this clinical trial, we aim to (1) assess the therapeutic clinical effects of taVNS in patients with DoC; (2) investigate the neural mechanisms underlying the effects of its action; (3) assess the feasibility and safety of the procedure in this challenging population; (4) define the phenotype of clinical responders; and (5) assess the long-term efficacy of taVNS in terms of functional outcomes. MethodsWe will conduct a prospective parallel randomized controlled double-blind clinical trial investigating the effects of taVNS as a treatment in DoC patients. Forty-four patients in the early period post-injury (7 to 90 days following the injury) will randomly receive 5 days of either active bilateral vagal stimulation (45 min duration with 30s alternative episodes of active/rest periods; 3mA; 200-300μs current width, 25Hz.) or sham stimulation. Behavioural (i.e., Coma Recovery Scale-Revised, CRS-R) and neurophysiological (i.e., high-density electroencephalography, hd-EEG) measures will be collected at baseline and at the end of the 5-day treatment. Analyses will seek for changes in the CRS-R and the EEG metrics (e.g., alpha band power spectrum, functional connectivity) at the group and individual (i.e., responders) levels. DiscussionThese results will allow us to investigate the vagal afferent network and will contribute towards a definition of the role of taVNS for the treatment of patients with DoC. We aim to identify the neural correlates of its action and pave the way to novel targeted therapeutic strategies. Clinical trial registrationClinicaltrials.gov n° NCT04065386.

Sacrococcygeal teratomas: a case-based review from the perspective of individual multidisciplinary experts.

Sacrococcygeal teratoma (SCT) is a rare congenital tumor originating from a variant of extragonadal germ cell neoplasm. Herein, we present three cases of neonatal SCTs undergoing surgical resection and reconstruction. We also review the literature to discuss the importance of proper perinatal management and timely surgical intervention depending on the tumor type and maturity to prevent malignant transformation and recurrence and ensure functional outcomes. Three cases of SCT were retrospectively analyzed. All infants underwent complete surgical resection of the SCT and coccygectomy during their neonatal/infancy period, followed by pelvic floor and buttock reconstruction while minimizing buttock contour deformity and undesirable skin scar. Two of the cases were histopathologically diagnosed as predominantly cystic mature teratomas of Altman types I and IV, and the third was a mature teratoma of Altman type II. There were no complications or tumor recurrence during the average follow-up period of 5.3years. This case-based review highlights the role of multidisciplinary team approaches, including prenatal monitoring, oncologic resection, and adequate reconstruction according to the type of tumor and anomaly. Optimal perinatal evaluation allows promising oncologic and functional outcomes in terms of timely intervention to eliminate tumor recurrence and malignant transformation. Complete oncologic surgical resection of SCTs should also include proper functional preservation strategies, such as the reconstruction of the pelvic floor, cosmetic buttock contouring, and preservation of bladder and bowel sphincter function.

Functional Outcome of Surgical Management of Tibial Plateau Fractures: A Prospective Observational Study

Background: Because of intra-articular nature, tibial plateau fractures are significant and difficult to manage. Low and high-energy tibial plateau fractures usually result from axial loading in combination with valgus stress forces, present a variety of soft tissue and bony injuries that can produce permanent disabilities. Although there are various modalities for fixation of these fractures with satisfactory results, but there is no general consensus as to which modality is the best in terms of functional outcome and proving the superiority of one over the other. Aim of the Study: The study aimed to evaluate the functional outcome of surgical management of tibial plateau fractures. Methods: It was a prospective observational study conducted in the Trauma Center, Bangabandhu Sheikh Mujib Medical College (BSMMC) &amp; Hospital, Faridpur, Bangladesh during the period from January 2021 to December 2021. In total 85 more than 20 years old patients of both sexes with tibial plateau fractures attended to the mentioned hospital during the first six months of the study were selected as the study population. Obeying the inclusion criteria of this study, only simple fractures of tibial plateau presenting in patients requiring open or closed reduction as well as internal fixation to restore the articular anatomy were finalized for this study. Result: In this study, according to the Schatzker classification and outcomes as per the recommendation of Rasmussen et al., 89% (n=76) patients got acceptable outcomes whereas the rest 11% (n=9) did not get satisfactory results. For majority (55%) of the patients, the union time was found &lt;12 weeks whereas in 2% cases (n=2) incidence of non-union was observed. Besides these, in general grading of patient’s outcome as per patient’s satisfaction, 56% patients got excellent results. Conclusion: In this study we found satisfactory outcomes in majority of the patients but in case of more than 10% cases outcomes were not acceptable. .............

Is a primary distal biceps tendon repair a matter of time? Comparison of functional outcome in a retrospective case-control study

Acute tendon ruptures are not always promptly recognized or referred appropriately, creating a delayed patients presentation to the surgeon. Previous reports have noted an increased complication rate of patients with a delay to surgery, however, there is a paucity of literature reporting functional outcomes of chronic/delayed distal biceps repair. With our clinical experience, we noticed that a chronic distal biceps tendon rupture can safely be directly repaired to the radial tuberosity. We hypothesized that delayed primary distal biceps tendon repair (> 21 days from injury) has similar functional outcomes and complication rate, compared to acute repair. A retrospective case-control study was used to compare the delayed (study) and acute (control) primary distal biceps tendon repair, performed between January 2017 and December 2021. Strength measurements were noted as a percentage of the unaffected contralateral side. Functional outcomes were recorded using the Visual Analog Scale, the Mayo Elbow Performance Score, the short version of the Disabilities of the Arm, Shoulder and Hand score and the Patient-Rated Elbow Evaluation. All questionaries, including Satisfaction, were completed at the final follow-up. All clinical records were evaluated for any adverse events. We selected 210 out of 217 patients. The study and control cohort consisted of 75 and 135 patients respectively. Time to surgery was 73 ± 66.05 days versus 11.27 ± 5.14 days respectively. At short term (4.79 ± 2.09 months), the functional outcome in terms of Mayo Elbow Performance Score, the short version of the Disabilities of the Arm, Shoulder and Hand score and the Patient-Rated Elbow Evaluation were statistically not significant different ( P = 0.354, P = 0.412 and P = 0.958, respectively). The mean flexion and supination strength were respectively 89.19 ± 13.43% and 77.48 ± 16.68%, similar for both cohorts ( P = 0.476 and P = 0.395, respectively). Significantly higher incidence of asymptomatic heterotopic ossification in the control cohort ( P = 0.006), however not difference in overall complication rate ( P = 0.072). At long term (28.9 ± 17.9 months), the functional outcomes remain similar. This study demonstrates that delayed primary distal biceps repair is reliable and overall safe Functional outcomes and strength did not changed with a delayed repair. There was a higher incidence of heterotopic ossification in acute distal biceps repair. The overall complication rate was similar, no matter what time to surgery.

Clinical outcomes and complications of laparoscopic sacrocolpopexy with versus without concomitant hysterectomy for pelvic organ prolapse in Hong Kong Chinese patients after median follow-up of 7 years.

This retrospective cohort study is aimed at comparing outcomes and complications of laparoscopic sacrocolpopexy (LSC) with or without concomitant hysterectomy in the Hong Kong Chinese population. Women with stage II or above uterine or apical vault prolapse who underwent LSC with or without concomitant hysterectomy in a regional referral unit from 2007 to 2019 were included. The primary objectives were to compare the anatomical outcomes by pelvic organ prolapse quantification system (POP-Q) and recurrence of apical vault prolapse (≥stage II). The secondary objective was to compare the functional outcomes and complications. Anatomical recurrence and incidence of mesh exposure were analyzed using the Kaplan-Meier method. Cox proportional hazard regression was performed to identify risk factors of anatomical recurrence. Seventy-six women were included for analysis. The recurrence rate of apical vault prolapse was 3.9% after a median follow-up time of 83 months (20-190 months). A significant reduction of POP-Q scores of three compartments in both groups of women were demonstrated (p<0.001). There was no difference between the two groups in terms of functional outcomes and complications. 6.6% of women developed mesh exposure. The time to recurrence of apical vault prolapse was shorter in women who had LSC with prior hysterectomy (p =0.019). No risk factors were identified for recurrence of apical vault prolapse. Laparoscopic sacrocolpopexy with concomitant hysterectomy is comparable with LSC alone. The recurrence and complication rates are low. We suggest that LSC with concomitant hysterectomy might be offered to women with pelvic organ prolapse, with women's preference taken into account.

Cast versus removable orthosis for the management of stable type B ankle fractures: a systematic review and meta-analysis

PurposeThere is currently no consensus on nonoperative management in adult patients after a stable type B ankle fracture. The aim of this review is to compare a removable orthosis versus a cast regarding safety and functional outcome in the NOM of stable type B ankle fractures.MethodsA systematic review and meta-analysis were performed using randomized clinical trials and observational studies. The methodological quality of the included studies was assessed with the methodological index for non-randomized studies instrument. Nonoperative management was compared using the number of complications and functional outcome measured using the Olerud and Molander Score (OMAS) or the American Academy of Orthopaedic Surgeons Ankle Score.ResultsFive studies were included. Two were randomized clinical trials, and three were observational studies, including a total of 516 patients. A meta-analysis showed statistically significant higher odds of developing complications in the cast group [odds ratio (OR), 4.67 (95% confidence interval (CI) 1.52–14.35)].Functional outcome in OMAS did not vary significantly at 6 weeks, mean difference (MD) − 6.64 (95% CI − 13.72 to + 0.45), and at 12 weeks, MD − 6.91 (95% CI − 18.73 to + 4.91). The mean difference of functional outcome in OMAS at 26 weeks or longer was significantly better in the removable orthosis group; MD − 2.63 (95% CI − 5.01 to − 0.25).ConclusionResults of this systematic review and meta-analysis show that a removable orthosis is a safe alternative type of NOM, as complication numbers are significantly lower in the orthosis group. In addition, no statistically significant differences were found in terms of functional outcome between a removable orthosis and a cast at 6 and 12 weeks. The 6-week and the 26-week OMAS results show that in patients with stable type B ankle fractures, a removable orthosis is non-inferior to a cast in terms of functional outcome.

Comparison of Twin Screw Derotation Type Versus Single Helical Blade Type Cephalomedullary Nail in Trochanteric Fractures in Geriatric Population.

Introduction The aim of this study was to compare the usage of two devices, the twin screw derotation typeand the helical blade type, in intertrochanteric fractures in the geriatric population at a tertiary-level center. Methods Forty-six eligible patients with intertrochanteric fractures operated with the standard proximal femoral nail (PFN) or proximal femoral nail anti-rotation (PFNA2) were included for analysis. This was a retrospective analysis of prospectively collected data over the study period. Demographics, various operative parameters, outcome parameters, and complications were assessed. Medical management of osteoporosis was provided to all patients. The student t-test and chi-square test were used with SPSS V22.0 (IBM Corp., Armonk, NY) for statistical analysis. Results The mean follow-up was 14 months. The hospital stay and Harris hip score were similar in both groups, but the radiation exposure, surgical time, and blood loss were significantly less in the case of PFNA2. Screw cut-out was also not observed in our study. Conclusion Both PFNA2 and PFN are effective in treating unstable trochanteric fractures in terms of functional outcomes. However, PFNA2 is better because it requires less radiation exposure (p<0.05) due to single guidewire use, a short learning curve, less blood loss, shorter surgical time(p<0.05), and fewer complications. We suggest it to be the preferred implant in trochanteric fractures in the geriatric population and other age groups.

Bilateral Knee Arthroplasty in Patients Affected by Windswept Deformity: A Systematic Review.

"Windswept" deformity (WSD) consists of a non-frequent condition in which the patient presents a valgus deformity in one knee and a varus deformity in the other. We performed a review of the available literature to aggregate the accessible data on the outcomes of bilateral knee arthroplasty in patients with WSD and to discuss the surgical challenges that this condition might pose. A systematic review of the literature following the PRISMA guidelines was conducted. The relevant studies between 1979 and 2021 were identified. Four studies with a total of 68 patients were included for analysis. The mean follow-up for varus knees was 3.3 years, 3.1 years for valgus knees. The quality and rigor of the included studies was assessed using the Methodological index for non-randomized studies (MINORS). All the studies reported improvement in knee function following knee replacement surgery, and a reduction in axial deviation of both knees, with similar results in valgus and varus knees in terms of patient satisfaction. The most relevant data were that unicompartmental knee arthroplasty (UKA) allowed for limited axial correction with slightly inferior functional results. Kinematic alignment (KA) allowed for similar results in both knees. The present review shows how satisfactory results can be achieved in both knees in patients with WSD and osteoarthrosis (OA). However, the operating surgeon should be aware of the importance of the implant choice in terms of functional outcomes. In the absence of extra-articular deformities, calipered KA total knee arthroplasty (TKA) can be performed on both knees with good axial correction and functional outcome. II -Systematic review of cohort studies.

A COMPARETIVE STUDY TO DETERMINE EFFECTIVENESS OF HIGH TIBIAL OSTEOTOMY AND PROXIMAL FIBULECTOMY FOR MEDIAL UNICOMPARTMENTAL KNEE OSTEOARTHRITIS IN MIDDLE AGE PATIENTS

This is a comparetive study that was conducted over a period of 18 months in Burdwan Medical College and Hospital, to determine the effectiveness of high tibial osteotomy and proximal bulectomy in management of non-traumatic medial uni-compartmental knee osteoarthritis in middle age group(40-60) years patients of both sexes. There were a total of 20 patients studied during a period of 18 months.It was found that though Pre-Op Femorotibial Angle was signicantly high in High Tibial Osteotomy patients compared to Proximal Fibulectomy patients, Post-Op Femorotibial Angle at 6 months and at 9 months was signicantly decreased in High Tibial Osteotomy compared to Proximal Fibulectomy patients. Also that Post-Op Medial /Lat Joint Ratio and Post-Op Medial Lat Joint Space at 6 months were signicantly decreased in Proximal Fibulectomy compared to High Tibial Osteotomy patients. The present study demonstrates the High tibial osteotomy effectively relieves the pain and improves the joint function in the patients with medial compartment osteoarthritis of knee by shifting the mechanical axis. Z test and Pearson correlation analysis shows Distribution of mean post-Op (6 months) Femorotibial Angle with Group was statistically signicant (p=0.0424). Distribution of mean post-Op (9 months) Femorotibial Angle with Group was statistically signicant (p=0.0491). However due to small numbers of sample size in my study, larger study is recommended to attain this conclusion. In conclusion, High tibial osteotomy seems to be a better option as compared to proximal bulectomy in terms of functional outcome.

A STUDY ON ROLE OF CORTICAL MASTOIDECTOMY IN CASES OF TYPE 1 TYMPANOPLASTY

Chronic otitis media (COM) is an inammatory process in the middle-ear space that results in long term, or permanent changes in the tympanic membrane including atelectasis, perforation, tympanosclerosis, retraction pocket development, or cholesteatoma [1]. COM is a major cause of acquired hearing impairment especially in developing countries.1 According to WHO, prevalence rate of COM in India accounts for 7.8% which is high.2 Perforation in tympanic membrane leads to hearing loss and recurrent ear infections. Persistent perforations occur either due to improper treatment of recurrent otitis media or infected traumatic perforation. Primary goal of treatment for COM (mucosal) is elimination of the chronic inammatory process. The secondary goal is reconstruction of sound conducting mechanism [10]. Tympanoplasty is a procedure to eradicate disease in the middle ear to reconstruct hearing mechanism with or without tympanic membrane grafting [2]. Various types of graft materials including temporalis fascia, cartilage, perichondrium, periosteum, vein, fat or skin have been used in the reconstruction of tympanic membrane (TM) perforation. Although temporalis fascia ensures good hearing is restored, there are signicant concerns that its dimensional stability characteristics may lead to residual perforation, especially where large TM perforations are involved. The “palisade cartilage” and “cartilage island” techniques have been stated to increase the strength and stability of a tympanic graft, but they may result in a less functional outcome in terms of restoring hearing[3]. Smoking habits, the size and site of a perforation, the expertise level of the operating surgeon, age, gender, the status of the middle ear mucosa and the presence of myringosclerosis or tympanosclerosis are all important in determining how successful a graft is[4].

Olecranon Osteotomy by a Gigli Saw versus Chevron's Osteotomy for Exposure of Intra-articular Distal Humerus: A Comparative Study.

Olecranon osteotomy is employed for the fixation of intraarticular distal humeral fractures. We conducted a prospective, randomised study comparing Chevron's osteotomy with olecranon osteotomy by a Gigli saw for exposure of the intraarticular distal humerus in terms of functional outcome and intra-operative ease of the surgery. Thirty patients with skeletally mature AO/OTA type 13- B and 13-C distal humerus fractures were randomly allocated to Chevron's or Gigli saw groups. Each group consisted of a total of 15 patients. Both the groups were assessed on post-operative parameters including arm, shoulder or hand pain, ability to perform certain routine activities, tingling sensations and pain while sleeping. In the Gigli saw group, 12 patients had no gross limitation of activity and 13 were able to perform moderate activities with ease. Similar results were observed in the Chevron's group. The mean difference between the two groups in Oxford Score was 0.60, within the 95% confidence interval and in line with QuickDASH-11 Score. Chevron's technique offers stability and better healing, providing a larger surface area for bone union. However, it is challenging and time-consuming. Also, literature suggests that the Gigli saw has multiple benefits, saves time and effort, and heals by switching blood supply from centrifugal to centripetal post-operatively. Our study suggests that both Chevron's technique and the use of the Gigli saw are effective in distal humeral intra-articular fractures as assessed by multiple parameters. Hence both techniques can be equally used depending on the surgeon's preference.

OUTCOME ANALYSIS OF DISTAL RADIUS FRACTURES TREATED WITH K-WIRES VS CASTING

Background Distal radius fracture has long been treated by closed reduction and casting . Although casting sufces in a proportion of cases, it may fail to maintaining the reduction is usually a problem. Hence, in a majority of cases, with cast satisfactory reduction can lost resulting in a poor anatomical and in some cases functional outcome. Percutaneous K-Wire xation1-3 is a simple way of providing additional stability to immobilization in casting an unstable fracture of distal radius in which acceptable anatomical reduction is obtainable. The technique is simple, minimally invasive and inexpensive. It is much less intrusive than other methods such as external xation. Though it has its own set of complications e.g. pin tract infection, supercial radial neuropathy etc. It still forms an effective tool in the surgical armamentarium for treatment of distal radius fractures. The present study was conducted at the de Methods partment of orthopaedics Andhra medical college/ king George hospital Visakhapatnam between 2020 and 2021.Sixty patients who fullled inclusion criteria were taken up for study n=60. They were randomly divided into two groups with 30 members each belonging to casting and k-wire xation groups. In Results both treatment methods radial length, ulnar variance, radial angulation are restored to near normal but correction of dorsal tilt is not complete. This is because the fact that volar ligaments are stronger on distraction before relatively 'Z' oriented dorsal ligaments. So, on distraction volar cortex is brought out to length before dorsal cortex preventing full correction of dorsal tilt.Cast immobilization alone could not maintain reduction in unstable fractures resulting in poor anatomical outcome.53% patients of cast immobilization had moderate to severe deformity, compared with only 11.76% patients of K wire and casting group having moderate deformity. At the end of 12 weeks, functional outcomes in the studied both types were almost similar with no signicant difference in DASH scores. At the end of the study, we concluded that Conclusion both the techniques of managements K wire xation and casting and closed reduction and casting gives near equal results in terms of functional outcome. Better anatomical reduction and maintenance of reduction can be expected with K wire xation and casting group.

ANTERIOR ELBOW DISLOCATION WITHOUT NEUROVASCULAR INJURY- A RARE CASE REPORT

Introduction- Of all the injuries around elbow joint, simple anterior elbow dislocation is of rare occurrence usually as a result of direct injury to proximal ulna after fall on semi-exed elbow. A 6year-old female child presente Case report- d to emergency department of our hospital with history of fall from 11 feet height followed by pain, deformity, swelling around left elbow and forearm. Digital radiographs suggestive of anterior elbow dislocation, which was managed successfully with closed reduction. Si Conclusion- mple anterior elbow dislocation in paediatric population is a rare entity and closed reduction is treatment of choice followed by physiotherapy under-supervision for good functional outcome in terms of range of motion.