Terms Of Functional Outcomes Research Articles

Flexor hallucis longus tendon transfer for Tendo Achillis reconstruction

Background: Tendo Achilles injuries are common in orthopaedic practice. Degenerative, Chronic and failed repaires requires some form of soft tissue sleeve augmentation like Flexor Hallucis longs (FHL), Peroneus Brevis (PB), Plantaris etc.. are used along with proximal Tendo Achilles advancement procedures lie V-Y plasty, musculo tendinous Recession or Turn Down Procedures. These advancement procedure leads to weakening of already compromised Tendon. So, wanted to evaluate functional outcome of FHL tendon Trans Tendinous Transfer without any Advancement procedures. Methods: 20 patients satisfying inclusion criteria underwent FHL Trans tendinous Transfer to Tendo Achilles which is secured with Interference screw into the prepared bone bed of calcaneum. Initially anterior slab in planter flexion was applied later converted to cast in neutral position which is removed at the end of 6 weeks and joint mobilization started. Results: Out of 20 patients,11 were male patients and 9 were females. Average age ranged from 22 to 65 years. 9 were chronic Tears,9 were Degenerative Tears and 2 were failed Repairs. Wound healing complications were seen in 4 cases, 1 with chronic tear, 1 with Degenerative Tear and Both Filed repairs, all of them healed eventually. ALL patients were assessed for AOFAS at 6th and 12thmonth. The mean AOFAS of each subgroup improved significantly from months 3 to 12 (Table). At the one-year follow-up, all patients achieved good functional outcome in terms of the AOFAS scoring system. Conclusions: Tendo Achilles is the common tendon injured in ankle region due to repetitive stress and degeneration. Degenerative, Chronic and failed repair injuries of Tendo Achilles requires some form of soft tissue augmentation for healing. Trans-Tendinous FHL tendon transfer for Tendo Achilles Reconstruction shows good results with minimal complications in these scenarios in non-Athletic Population.

Reconstruction of proximal hamstring ruptures restores joint biomechanics during various walking conditions.

We aimed to examine the functional outcome in different walking conditions in elderly adults who underwent surgical repair after a non-contact hamstring injury. Our objective was to compare lower limb kinematics and kinetics over the entire gait cycle between the injured and contralateral leg in overground and level and uphill treadmill walking. 12 patients (mean ± SD, age: 65 ± 9 years; body mass index: 30 ± 6 kg/m2) walked at self-selected speed in overground (0% slope) and treadmill conditions (0% and 10% slope). We measured spatiotemporal parameters, joint angles (normalised to gait cycle) and joint moments (normalised to stance phase) of the hip, knee and ankle. Data between sides were compared using paired sample t-tests (p < 0.05) and continuous 95% confidence intervals of the paired difference between trajectories. Patients walked at an average speed of 1.31 ± 0.26 m/second overground and 0.92 ± 0.31 m/second on the treadmill. Spatiotemporal parameters were comparable between the injured and contralateral leg (p > 0.05). Joint kinematic and joint kinetic trajectories were comparable between sides for all walking conditions. Refixation of the proximal hamstring tendons resulted in comparable ambulatory mechanics at least 1 year after surgery in the injured leg and the contralateral leg, which were all within the range of normative values reported in the literature. These results complement our previous findings on hamstring repair in terms of clinical outcomes and muscle strength and support that surgical repair achieves good functional outcomes in terms of ambulation in an elderly population. clinicaltrials.gov (NCT04867746).

Functional and Neuropsychological Outcome After Surgical Treatment of Moyamoya Disease

IntroductionMoya Moya disease(MMD) is a rare cerebrovascular disease characterized by progressive stenosis of the supraclinoid ICA. Due to chronically decreased brain perfusion, eloquent areas of the brain become hypo-perfused leading to cognitive changes in patients. Repeated infarcts and bleeds produce clinically apparent neurological deficits. Aim and Objective1) To study the functional and neuropsychological outcome in Moya Moya Disease following revascularization surgery.2) To find post revascularisation correlation between functional and neuropsychological improvement and radiological improvement. Material and methodA single-center prospective and analytical study including 21 patients of MMD during the study period from March 2021 to December 2022. Patients were evaluated and compared in the pre-and post-revascularization for functional, neuropsychological, and radiological status. ResultPost-operative functional outcome in terms of modified Rankin Score showed improvement in 33.33% of cases (p-value = 0.0769). An overall improving trend was observed in different neuropsychological domains in both adult and pediatric age groups. But, the trend of neuropsychological improvement was better in adults as compared to the pediatric patients. Radiological outcome in the forms of the Angiographic Outcome Score (AOS) significantly improved after post-revascularization (p-value = 0.0001). There was a trend towards improvement in MRI perfusion in the MCA and ACA territories, 4.7% (p-value=0.075) and 9.33% (p-value-0.058) respectively, as compared to preoperative MRI perfusion. ConclusionsPost revascularisation, significant improvement occurred in functional and neuropsychological status. This was also demonstrated radiologically as evident by improvement in MRI perfusion and cerebral angiography.

Inflammatory markers and functional outcome score in different subgroups of ischaemic stroke: a prospective cohort study

BackgroundAcute ischaemic stroke (AIS) is a leading cause of disability and mortality worldwide. Determining subgroups and outcomes of AIS may lead to better treatment. We aimed to investigate the relationship...

Comparison of Bipolar and Monopolar Transurethral Resection of the Prostate, Functional Outcomes and Analysis of Factors Predictive of Complications: A Prospective Study

Introduction: In Morocco, RTUP-m is considered the gold standard for the surgical treatment of prostate adenomas, recommended for prostates with a volume suitable for resection in less than 60 minutes. Additionally, the challenge arises when dealing with patients on antiplatelet or anticoagulant medications due to the associated risk of bleeding, hence the significance of RTUP-b. The objective of our study is to compare the functional outcomes and immediate postoperative complications between these two techniques and to identify predictive factors for complications. Methods: This is a prospective randomized study conducted between January 2022 and September 2022. The variables age, BMI, surgical indication, transrectal prostate volume, ASA classification (American Society of Anesthesiologists), previous pharmacological treatments, IPSS score, quality of life index (QLI), maximum flow rate (Qmax) and postoperative complications were collected. The Chi2 test and Student's t-test were used for statistical analysis. Results: Sixty-nine consecutive patients were included, 38 patients in the monopolar TURP group and 31 in the bipolar TURP group. Both groups were homogeneous in their baseline characteristics. The overall pre-surgical IPSS/QLI/Qmax score was 24,03/4,73/9,47. Functional results at 1st and 3rd month are shown in Table 1. For complications, see Table 2 and 3. These differences were not statistically significant (p = 0,427): the most frequent were hematuria (9,4%) and febrile urinary tract infections (9,4%). Only one patient presented hyponatremia due to glycocol reabsorption in the monopolar group. All complications were Clavien 1 or 2. We found no significant differences between the two groups with regard to complications or their predictive factors. Conclusion: Analysis of our data over the first three months reveals no differences between the two techniques in terms of functional results and postoperative complications, and there are no predictive .........

Long-term functional swallowing and speech outcomes after transoral robotic surgery for oropharyngeal cancer.

Transoral robotic surgery (TORS) has emerged as a minimally invasive approach for oropharyngeal cancer, aiming to improve functional preservation and reduce morbidity. However, the long-term effects on speech and swallowing, crucial aspects of quality of life, remain unclear. This study investigates the long-term functional swallowing and speech outcomes of TORS for oropharyngeal cancer. We retrospectively reviewed 41 patients diagnosed with oropharyngeal squamous cell carcinoma who underwent TORS from 2010 to 2018. Tongue mobility, articulation, verbal diadochokinesis, reading speed, and modified barium swallowing tests were performed 2-3 years post-operatively to assess long-term speech and swallowing function. The mean age was 57.7 ± 9.9 years, and the male to female ratio was 34:7. The palatine tonsil was the most common tumor site (73.2%), followed by the base of tongue (22.0%). Concurrent neck dissection was performed in 97.6% of patients, and adjuvant radiation or chemoradiation was administered to 36 patients (87.8%). Tongue mobility, articulation, verbal diadochokinesis, and reading speed were comparable to normal population. Modified barium swallowing tests revealed acceptable outcomes in most patients; only one patient (2.4%) required a percutaneous endoscopic gastrostomy tube. Notably, no permanent tracheostomies were necessary. Long-term speech and swallowing functions were preserved in most patients treated with TORS for oropharyngeal cancer. TORS is an excellent treatment modality for oropharyngeal cancer in terms of functional outcomes.

Functional Results of Cataract Surgery at the Secondary Ophthalmology Center of Ouelessebougou: A Study of 170 Cases

Cataract remains a significant public health issue in developing countries, and its treatment is predominantly surgical. The aim of this study was to evaluate extracapsular extraction using manual phaco alternative without sutures in terms of functional outcomes. This prospective study took place from January 2023 to June 2023, involving 170 eyes followed up to day 30 at the secondary ophthalmology center in Ouelessebougou. Data were analyzed using IBM SPSS and Excel 2016. Almost all our patients, 95% in Phaco-A and 93.3% in ECCE+PCI, underwent biometry. At day 30 postoperatively with correction, the phaco alternative yielded 88.8% good results, and extracapsular extraction showed 72.2% good results. At day 30 with correction, Phaco-A resulted in 88.75% of patients achieving good visual acuity compared to 72.22% in ECCE+PCI. This result is comparable to those of Konaté M [17] and Windinmanegdé Djiguimdé et al., [18], who achieved 83.49% and 79.6% good visual acuities, respectively. Phaco alternative provides better postoperative results in cataract surgery at the secondary ophthalmology center of Ouelessebougou.

A Retrospective Analysis of Dynamic Compression Plating Versus Intramedullary Nailing for the Management of Shaft of Humerus Fractures in an Urban Trauma Care Center.

Introduction There is constant debate regarding the best surgical technique for the fixation of shaft humerus fractures. Intramedullary nailing and dynamic compression plating are the most popular surgical options. Materials and methods In our study, we retrospectively analyze the results of 27 patients with shaft humerus fractures managed with intramedullary nailing (10) and dynamic compression plating (17) at our institute from September 2021 to October 2022. Preoperative clinical assessment sheets, postoperative follow-up sheets, operative notes, anesthesia sheets, and preoperative and follow-up radiographs were analyzed. Reamed antegrade nailing was done in all cases, while dynamic compression plating was done through a posterior approach. Results The operative time of the nailing group was 82.1 ± 7.61 mins, which was significantly lesser (P value <0.05) than that of the plating group, which was 119.59 ± 10.16 mins. The intraoperative blood loss of the patients who were managed with nailing was 71 ± 7.38 mL, which was significantly lesser (P value <0.05) than that of the plating group, which was 130.59 ± 11.44 mL. The patients in both groups had a statistically nonsignificant difference in terms of functional results, which were assessed using Rodriguez-Merchan criteria. Complications were similar in both groups with infection (17.65%), and postoperative radial nerve palsy (11.76%) was more common among the patients undergoing plating, and shoulder impingement(20%) was common among those undergoing nailing. Conclusion This study concluded that both surgical options are similar in the case of functional results. The selection of the surgical method should be as per the surgeon's surgical familiarity and personalized to individual patients.

Proximal Fibular Osteotomy Vs Proximal Fibular Osteotomy with Intra-Articular Hyaluronic Acid: Difference in Terms of Pain Relief and Functional Outcome

Background: Knee osteoarthritis (OA) is a complex, progressive illness marked by cartilage deterioration and adjacent bone enlargement, and management is challenging due to poor connective tissue self-regeneration. This study compared the effects of proximal fibular osteotomy (PFO) alone versus PFO with intra-articular hyaluronic acid injections (IAHA) among patients presenting with knee OA. Methods: A quasi-experimental study was done at Ziauddin Hospital’s orthopedics department from March 2020 to March 2021. Patients with medial compartment knee joint OA requiring surgery aged≥40 years and BMI of &lt;30kg/m2 were included. All participants were assigned into two groups, PFO was done alone in group A (n=30) and with IAHA in group B (n=30). Both groups had their medial joint spaces measured and documented pre- and post-operatively, as well as their Oxford knee score and visual analog scale (VAS). SPSS version 25 was used and the normality of data was assessed using Shapiro-Wilk’s test. The mean difference (post-pre) was compared using the Mann-Whitney U test. A p≤0.05 was statistically significant. Results: A total of 60 patients were included with a mean age of 51.30±4.87 in Group A and 50.83±6.17 in Group B. Outcomes in both groups were improved considerably with a significant p&lt;0.0001 in groups, in terms of pain and function determined using Oxford knee score, medial joint space measurement, and VAS score. Conclusion: PFO alone and PFO with IAHA show significantly improved results in terms of functional outcomes, but the use of IAHA in combination with PFO, has considerably better results in terms of pain relief.

A Comparison of Functional Outcome of Open Reduction Internal Fixation Versus Ilizarov External Fixation in Complex Proximal Tibial Fractures: Randomized Controlled Trial

Objective: Proximal tibia fractures can be treated with open reduction and internal fixation (ORIF), hybrid fixation, or external fixation; however, it is still unknown which method is better than the others. The purpose of the study was to compare the clinical and functional outcomes handled by Ilizarov and ORIF in order to determine the gold standard treatment choice for proximal tibia fractures. This study aimed to compare the functional outcomes of open reduction internal fixation and Ilizarov external fixation in the treatment of complicated proximal tibial fractures.&#x0D; Methodology: An RCT was carried out in the Orthopaedic Department at PIMS Islamabad. It was carried out during a 12-month period after the synopsis was approved.This study included 104 patients with Schatzker's grade IV–VI fractures who presented to the orthopaedic department at PIMS, Islamabad. Using the lottery approach, the patients were split into two treatment groups at random. Group B uses the Ilizarov External Fixation procedure, while Group A uses the Open Reduction and Internal Fixation (ORIF) technique. Every three weeks, post-operative follow-ups were conducted. Up until the fracture healed, post-operative radiographs were taken every three weeks. Every patient had a 24-week clinical follow-up. At the follow-up appointment, each patient's outcomes were documented in accordance with the operational definition. SPSS was used to enter and process all of the data.&#x0D; Using SPSS v25.0, all of the data were input and processed. The surgery time, VAS score, and length of hospital stay were compared between the two groups using an independent sample t-test. The functional outcome at six months was compared between the two groups using the Chi-square test. A significant p-value was defined as ≤0.05.&#x0D; Results: There were 31 (59.6%) men and 21 (40.4%) women in group A, and 36 (69.2%) men and 16 (30.8%) women in group B.In group A, the mean age was 44.87±14.15 years, while in group B, it was 44.25±15.68 years. In terms of functional outcome, 22 (42.3%) of the ORIF technique group had excellent outcomes, while 10 (19.2%), 16 (30.8%), and 4 (7.7%) had good, fair, and poor outcomes, respectively. In contrast, 35 (67.3%) of the Ilizarov technique group had excellent outcomes, while 10 (19.2%), 5 (9.6%), and 2 (3.8%) had good, fair, and poor outcomes, respectively. These results have a statistically significant p-value of 0.024.&#x0D; Conclusion: Compared to open reduction and internal fixation, Ilizarov external fixation is a more reliable method for fixing complicated proximal tibial fractures. For patients with complicated proximal tibial fractures, the Ilizarov external fixation approach yields superior functional outcomes than the open reduction internal fixation technique.&#x0D; KEY WORDS: Proximal Tibia Fracture, Open Reduction , Internal Fixation, Ilizarov External Fixation.

Functional Outcome of Subvastus versus Medial Parapatellar Approaches for Total Knee Replacement in Patients with Knee Osteoarthritis: A Prospective Cohort Study.

Subvastus approach and medial parapatellar approach are two major approaches for total knee replacement (TKR). There is no global consensus on the superiority of either approach in terms of functional outcomes. The present study aimed to evaluate the functional outcome of TKR through subvastus approach and medial parapatellar approach by using patient-reported scores at 3-, 6-, and 12-month post-operative follow-ups. This prospective cohort follow-up study included patients with knee osteoarthritis who underwent elective primary TKR either through the subvastus or medial parapatellar approaches at King Abdullah Medical City, Makkah city, Kingdom of Saudi Arabia, from January 2019 to December 2022. Scores from the self-reported Oxford Knee Score (OKS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) were compared in the two groups of patients at 3-, 6-, and 12-month post-operative follow-ups. A total of 98 patients were included, of which 37 underwent TKR through the subvastus approach and 61 through the medial parapatellar approach. There was an overall significant change over time in both WOMAC and OKS scores (P < 0.001). Patients who underwent the subvastus approach had significantly higher mean of WOMAC and OKS than patients with the medial parapatellar approach at the 3- and 6-month follow-ups (P < 0.05), but not at the 12-month follow-up. For TKR, the medial parapatellar approach results in better functional outcomes at the 3- and 6- month follow-up periods compared with the subvastus approach.

Computer Vision and Machine-Learning Techniques for Automatic 3D Virtual Images Overlapping During Augmented Reality Guided Robotic Partial Nephrectomy.

The research's purpose is to develop a software that automatically integrates and overlay 3D virtual models of kidneys harboring renal masses into the Da Vinci robotic console, assisting surgeon during the intervention. Precision medicine, especially in the field of minimally-invasive partial nephrectomy, aims to use 3D virtual models as a guidance for augmented reality robotic procedures. However, the co-registration process of the virtual images over the real operative field is performed manually. In this prospective study, two strategies for the automatic overlapping of the model over the real kidney were explored: the computer vision technology, leveraging the super-enhancement of the kidney allowed by the intraoperative injection of Indocyanine green for superimposition and the convolutional neural network technology, based on the processing of live images from the endoscope, after a training of the software on frames from prerecorded videos of the same surgery. The work-team, comprising a bioengineer, a software-developer and a surgeon, collaborated to create hyper-accuracy 3D models for automatic 3D-AR-guided RAPN. For each patient, demographic and clinical data were collected. Two groups (group A for the first technology with 12 patients and group B for the second technology with 8 patients) were defined. They showed comparable preoperative and post-operative characteristics. Concerning the first technology the average co-registration time was 7 (3-11) seconds while in the case of the second technology 11 (6-13) seconds. No major intraoperative or postoperative complications were recorded. There were no differences in terms of functional outcomes between the groups at every time-point considered. The first technology allowed a successful anchoring of the 3D model to the kidney, despite minimal manual refinements. The second technology improved kidney automatic detection without relying on indocyanine injection, resulting in better organ boundaries identification during tests. Further studies are needed to confirm this preliminary evidence.

The effectiveness and safety of rectal modular dissection for male middle and low rectal cancer after neoadjuvant chemoradiation therapy: the short-term outcome.

Background: The purpose of this study was to assess the efficacy and safety of rectal modular dissection (RMD) in male patients with middle and low rectal cancer. RMD is a technique used to guide the surgical procedure for rectal mobilization, with the ultimate goal of achieving total mesorectal excision. In order to evaluate the effectiveness of RMD, a single-center, non-inferiority randomized clinical trial was carried out. Methods: Eligible patients were randomly assigned into two groups: the RMD group and the traditional rectal mobilization (TRM) group. Demographic characteristics, perioperative data and pathological results of the surgical specimens were collected for analysis. additionally, assessments of urogenital function and defecation function were conducted for all participants. Results: A total of 103 patients (RMD group 53 patients and TRM group 50 patients) were included to analyzed. There were no significant differences in age, body mass index, ASA classification, and tumor characteristics between two groups. The RMD group had significantly lower blood loss (P = 0.00), shorter operative duration (P = 0.00), and shorter hospital stay (P = 0.04) compared to the TRM group. The complete rate of mesorectal excision was higher in the RMD group (98.1%) compared to the TRM group (86.0%, P = 0.02). In terms of functional outcomes, the RMD group had better evaluation scores for urethral function (IPSS score, P = 0.01), erectile function (IIEF-5 score, P = 0.00) and defecation function (LARS score, P = 0.00) at the one-year postoperative follow-up. The 1-year disease-free survival rate was similar between the two groups (P = 0.28). Conclusions: These results suggest that RMD is an effective and safe approach for achieving total mesorectal excision while promoting better functional outcomes for patients. The trial was registered in Chinese Clinical Trial Registry (ChiCTR2100052094).

Efficacy and safety of steroids for chronic subdural hematoma: A systematic review and meta-analysis

Background: Chronic subdural hematoma (CSDH) is a condition characterized by the accumulation of fluid, blood, and blood breakdown products between the brain’s arachnoid and dura mater coverings. While steroids have been explored as a potential treatment option, their efficacy and safety remain uncertain. This meta-analysis and systematic review aimed to assess the impact of steroids on CSDH management, including mortality, recurrence, complications, and functional outcomes. Methods: We conducted a comprehensive literature search in major electronic databases up to June 2023, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and Cochrane Handbook for Systematic Reviews and Interventions. Inclusion criteria encompassed adult patients with CSDH, the use of steroids as monotherapy or adjuvant therapy, and clearly defined outcomes. Randomized controlled trials and cohort studies meeting these criteria were included in the study. Results: The initial search yielded 4315 articles, with 12 studies meeting the inclusion criteria. Our findings indicate a non-significant trend toward reduced mortality with steroids in combination with standard care (Odds ratios [OR] = 0.66, 95% confidence interval [CI] 0.20–2.18). However, substantial heterogeneity was observed (I2 = 70%). Sensitivity analysis, excluding influential studies, suggested a potential increased mortality risk associated with steroids (OR = 1.47, 95% CI 0.87–2.48). Steroids showed a possible benefit in reducing the recurrence of CSDH (OR = 0.58, 95% CI 0.20–1.67), but with significant heterogeneity (I2 = 89%). No clear advantage of steroids was observed in terms of functional outcomes at three months (modified Rankin scale scores). Furthermore, steroids were associated with a significantly higher incidence of adverse effects and complications (OR = 2.17, 95% CI 1.48–3.17). Conclusion: Steroids may have a potential role in reducing CSDH recurrence but do not appear to confer significant advantages in terms of mortality or functional outcomes. However, their use is associated with a higher risk of adverse effects and complications. Given the limitations of existing studies, further research is needed to refine the role of steroids in CSDH management, considering patient-specific factors and treatment protocols.

Telescopic Overdenture Rehabilitation Following Hemimandibulectomy: Case Report

Oral squamous cell carcinoma (OSCC) warrants extensive surgical resection of the affected areas of the oral cavity which takes a tremendous toll on the patient’s functioning, aesthetic as well as social confidence. Replacement of such a large number of teeth along with portions of the alveolar ridge and mucosa warrants exuberant planning to ensure a satisfactory outcome in terms of function and patient comfort. The present case report describes one such case of OSCC that was treated with partial mandibular resection and had a large mandibular defect that was rehabilitated by means of a prosthesis using an interdisciplinary approach.

Assessing the impact of obesity on full endoscopic spine surgery: surgical site infections, surgery durations, early complications, and short-term functional outcomes.

An increasing number of obese patients undergoing elective spine surgery has been reported. Obesity has been associated with a substantially higher number of surgical site infections and a longer surgery duration. However, there is a lack of research investigating the intersection of obesity and full endoscopic spine surgery (FESS) in terms of functional outcomes and complications. The aim of this study was to evaluate wound site infections and functional outcomes following FESS in obese patients. Patients undergoing lumbar FESS at the participating institutions from March 2020 to March 2023 for degenerative pathologies were included in the analysis. Patients were divided into obese (BMI > 30 kg/m2) and nonobese (BMI 18-30 kg/m2) groups. Data were collected prospectively using an approved smartphone application for 3 months postsurgery. Parameters included demographics, surgical details, a virtual wound checkup, the visual analog scale for back and leg pain, and the Oswestry Disability Index (ODI) as a functional outcome measure. A total of 118 patients were included in the analysis, with 53 patients in the obese group and 65 in the nonobese group. Group homogeneity was satisfactory regarding patient age (obese vs nonobese: 55.5 ± 14.7 years vs 59.1 ± 17.1 years, p = 0.25) and sex (p = 0.85). No surgical site infection requiring operative revision was reported for either group. No significant differences for blood loss per level (obese vs nonobese: 9.7 ± 16.8 ml vs 8.0 ± 13.3 ml, p = 0.49) or duration of surgery per level (obese vs nonobese: 91.2 ± 57.7 minutes vs 76.8 ± 39.2 minutes, p = 0.44) were reported between groups. Obese patients showed significantly faster improvement regarding ODI (-3.0 ± 9.8 vs 0.7 ± 11.3, p = 0.01) and leg pain (-4.4 ± 3.2 vs -2.9 ± 3.7, p = 0.03) 7 days postsurgery. This effect was no longer significant 90 days postsurgery for either ODI (obese vs nonobese: -11.4 ± 11.4 vs -9.1 ± 9.6, p = 0.24) or leg pain (obese vs nonobese: -4.3 ± 3.9 vs -3.5 ± 3.8, p = 0.28). The results highlight the effectiveness and safety of lumbar FESS in obese patients. Unlike with open spine surgery, obese patients did not experience significant increases in surgery time or postoperative complications. Interestingly, obese patients demonstrated faster early recovery, as indicated by significantly greater improvements in ODI and leg pain at 7 days after surgery. However, there was no difference in improvement between the groups at 90 days after surgery.

A PROSPECTIVE STUDY TO ASSESSTHE FUNCTIONAL OUTCOMES OFDIAPHYSEAL BOTH BONE FRACTURESOF THE FOREARM IN ADULTS TREATEDBY OPEN REDUCTION AND INTERNALFIXATION WITH DYANAMICCOMPRESSION PLATE

Indroduction: Forearm fractures can be regarded as articular fractures as slight deviations in the spatial orientation of the radius and ulna will significantly decrease the forearmÂ’s rotational amplitude and thereby impair the positioning and function of the hand. Thus, the management of these fractures deserve special attention as their treatment is not the same as the treatment of other diaphyseal fractures.Open reduction and internal fixation for diaphyseal fracture in the adults are generally accepted as the best method of treatment, even though closed reduction may be achieved. Objective: The Objective of this study is to evaluate the functional outcome after open reduction and internal fixation of the forearm diaphyseal fractures by Dynamic Compression Plate (DCP). Methods: This is a prospective study of 72 cases of diaphyseal both bone forearm fractures in adults who attended casualty and of Government Medical College Hospital, Kozikkode and were treated by open reduction and internal fixation with dynamic compression plating between September 2020 to August 2022. Results: The functional outcome as per DASH scoring system in dynamic compression plating (DCP) group was that 85 % (61 patients) had excellent results, 15 % (11 patients) had good results with no patient having fair and poor results. Conclusion: Fixation with Dynamic Compression Plate has stood the test of time and provides excellent fixation. DASH is a widely accepted standardized scoring system to assess upper limb function. In comparison with few of the previous studies our results are better in terms of functional outcome.

Impact of Hepatitis B on Complications and Functional Outcomes in Patients Undergoing TKR.

In India, infected patients with hepatitis B virus (HBV) undergoing total knee replacement (TKA) are increasing. It is recognized that patients with HBV infection are more susceptible to complications after surgery. To evaluate the effect of HBV infection on complications and functional outcome after TKA was the aim of this study. This is the retrospective observation analysis of patients who underwent primary total knee replacement in our hospital from 2017 to 2019. A total of 92 patients were included in the study, of which 46 patients were asymptomatic HBV-positive, and these 46 patients were compared with a matched cohort of another 46 patients who were non-HBV. A total of 92 patients were analyzed (asymptomatic HBV n = 46, non-HBV n = 46). The incidence rate of total complications in patients undergoing TKA with asymptomatic HBV was 19.57% compared to 4.3% in non-HBV (p < 0.001). Applied with regression models, patients with HBV had an 8.6% increased risk of surgical complication which included one peri-prosthetic joint infection, three wound dehiscence compared with the non-HBV group which had 2.17% surgical complications (one wound dehiscence). Medical complications were higher in asymptomatic HBV group with 10.87% (which includes one pulmonary embolism, two DVT, and two strokes). In comparison with the non-HBV group which had 2.17% medical complications (one DVT), asymptomatic HBV group had 5.35-fold (95% CI 1.09-26.33; p < 0.01) increase in overall complications. Post-TKA surgical complications are 4.29-fold (95% CI 0.46-39.91; p < 0.01) higher compared to non-HBV group. Our study showed asymptomatic hepatitis B patients are at an increased risk of complications (peri-prosthetic joint infections and wound dehiscence) compared to normal patients. In hepatitis B and non-hepatitis B patients, functional outcomes in terms of OKS are comparable.

Geographic atrophy - Signs, symptoms, and quality of life.

Geographic atrophy (GA) is a prevalent cause of vision loss among elderly and is associated with a significant loss of function. We reviewed the current literature to assess the effect of GA on patients' daily lives and well-being. We record and organize the signs, symptoms, and impacts that are important in life with GA. Further, we examined the impact of GA on vision-related quality of life. The main complaint among patients was difficulties regarding daily tasks, especially reading and other near activities. However, a large proportion of patients also reported fear, frustration, and anxiety as salient symptoms with large impact. Many patients do not have adequate information about their condition as well as the prognosis. The most commonly used measure of patient-reported outcome measure (PROM) is the National Eye Institute Visual Function Questionnaire (VFQ), that reflects the severity of impact on 12 subscales, from where near activities, general vision, mental health, and role difficulties had the lowest scores. Longitudinal studies of GA and the impact of low-vision rehabilitation efforts on health-related quality of life are sparse but suggest a significant improvement on several items. PROM is included in clinical trials, and so far, no drug has shown to improve the functional outcome in terms of PROM.

Functional outcome in patients with hip fracture from 2008 to 2018, and the significance of hand-grip strength – a cross-sectional comparative study

BackgroundIncidence of hip fracture is estimated to rise, increasing demands on healthcare. Our objective was to compare patients with hip fracture, a decade apart, regarding surgical characteristics and functional outcome in relation to morbidity. A secondary aim was to analyse postoperative hand-grip strength (HGS) in relation to walking ability 4 months postoperatively.MethodsThis is a cross-sectional comparative study of patients with hip fracture, included in 2008 (n = 78) and 2018 (n = 76) at Örebro University Hospital. Patient-data (age, gender, morbidity, fall-circumstances, fracture, surgical characteristics, and length of stay) were collected from medical records. HGS was measured postoperatively. Data on functional outcome in terms of housing, walking ability and need of walking aids at 4 months postoperatively was collected from the Swedish Hip Fracture Register RIKSHÖFT. Statistical analyses adapted were hypothesis tests and regression analysis.ResultsPatients in 2018 presented a significantly higher morbidity than patients in 2008 and there were significant differences in adapted surgical methods. Functional outcome at 4-months postoperatively was analysed by logistic regression where Cohort 2018 was associated with higher odds of independent walking ability (OR 5.7; 95%CI 1.9–17.2) and not needing any walking aids (OR 5.1; 95%CI 1.9–17.2). Postoperative HGS was higher among patients in 2018 and a multiple regression analysis revealed a significant association between HGS and walking ability at 4 months postoperatively.ConclusionsThis study supports the since previously reported development in hip fracture surgery in Sweden while also presenting that functional outcome seems to have improved despite a concomitant increase in morbidity. Results suggest an improvement in postoperative HGS, predicting walking ability at 4 months postoperatively.