Significant Difference In Functional Outcome Research Articles

Comparative study of functional outcomes of arthroscopic anterior cruciate ligament reconstruction using anteromedial portal and translateral all-inside technique

BackgroundAnterior Cruciate Ligament (ACL) injuries are common in the active population of the Armed Forces. Symptomatic instability prompts individuals to seek a cure or a sheltered appointment. Despite the increasing numbers of ACL reconstructions performed, the outcomes have not been so spectacular with only a meager percentage of our patients returning to preinjury levels of activity. With the premise that an all-inside ACL reconstruction is likely to result in better functional outcomes, the aim of this study was to compare the short-term functional outcomes of a large consecutive series of patients undergoing ACL reconstruction using the translateral all-inside ACL reconstruction technique (AI) and standard anteromedial portal technique (AM) with a minimum follow-up of one year. MethodsA total of 240 patients with isolated ACL tear underwent ACL reconstruction via the AI or AM technique. Their preoperative and postoperative scores were compared to look for any significant differences in functional outcomes. ResultsThe two groups were matched for age, BMI, mechanism of injury, and interval from injury to surgery. There was no difference in their preoperative scores. Postoperatively, although there were significant improvements across both groups, there was no significant difference between the groups at any point of time. ConclusionThe AI technique has garnered interest in recent literature in addressing ACL injuries. This study found no discernible benefit of the AI technique when compared to the AM technique in terms of functionality following an ACL reconstruction at any point of time up to 1 year following surgery.

The Effects of Tibialis Anterior Tenotomy on Wound Complications and Functional Outcomes After Anterior Fusion Plating for Severe Ankle Arthritis

Nonunion is known to be a relatively common complication following ankle arthrodesis. Various fixation techniques have been introduced to enhance the stability and to improve fusion rate. With the use of anterior plate supplementation, postoperative wound problems have been frequently reported despite better fusion rate. This study was performed to determine the effects of tibialis anterior (TA) tenotomy on wound complications and functional outcomes after anterior fusion plating for severe ankle arthritis. Forty-six patients who underwent ankle arthrodesis using anterior fusion plate were followed for more than 2 years. TA tenotomy was performed prior to wound closure in all patients. As a control group, 38 patients who underwent arthrodesis without TA tenotomy were analyzed. Functional outcomes were evaluated with Ankle Osteoarthritis Scale and Foot and Ankle Ability Measure. Wound complication rate, time to fusion, fusion rate, time to pain relief were evaluated. Mean Ankle Osteoarthritis Scale and Foot and Ankle Ability Measure scores significantly improved to 32.6 and 69.4 points at final follow-up, respectively. As compared to control group (33.8 and 67.7 points), there were no significant differences in functional outcomes. As postoperative wound complications, there were 1 case of wound dehiscence and 1 case of superficial wound infection. TA tenotomy group showed a significantly lower wound complication rate (4.3%) than control group (23.7%) (p < .001). While there were no significant differences in fusion rate, time to fusion, and time to pain relief between both groups, control group needed higher rate of implant removal. Ankle arthrodesis using anterior fusion plate in conjunction with TA tenotomy appears to be an effective surgical option for end-stage ankle arthritis, with excellent fusion rate and less wound complication rate. Although there were no specific functional deficits related to absence of TA tendon, further studies are needed to determine long-term effects of TA tenotomy in patients with a fused ankle.

Comparación del daño tisular entre los abordajes lateral y anterior para la prótesis total de cadera.

Introduction: The objective was to compare the tissue damage caused by the anterior and lateral approaches for a total hip replacement. Methods: Prospective cohort study comparing patients undergoing total hip replacement using an anterior or lateral approach. Tissue damage was assessed by serum levels of interleukin, tumor necrosis factor, and acute-phase reactants, and magnetic resonance imaging. Function was assessed with the Harris hip scale. Results: The parameters of tissue damage were significantly higher early with the lateral approach, although equalizing towards 30 postoperative days. There were no significant differences in functional outcome at 3 and 12 months. Conclusion: Although the lateral approach presents greater tissue damage in the early postoperative period, the functional outcome and speed of recovery in the short-term are similar between both approaches.

Comparison of Open reduction and internal fixation by Stabilization with cross K-wires in early versus late presentation of Supracondylar Humeral Fractures in Children

Objective: To compare open reduction and internal fixation by stabilization with cross k-wires in early (within 6 days of injury) versus late (2 to 4 weeks) presentation of supracondylar humeral fractures in children. Study Design: A quasi experimental study Place and Duration: Department of Orthopedic, Lahore General Hospital, Lahore from 1st January 2021 to 30th June 2021. Methodology: A total of 42 cases (21 children in Group-A with early presentation and 21 in Group-B with late presentation) of Gartland’s type II and III humeral supracondylar fracture were included. All open reduction and internal fixation procedures were done by a single surgical team while post-surgical follow up consisted of 3-months. Functional and cosmetic outcome of surgery were observed in terms of decrease in carrying angle and elbow movements as per Flynn’s criteria. Results: Out of a total of 42 cases, there were 71.4% male and 28.6% female. The mean age of children in Group-A was 8.29±1.85 years while it was 7.43±2.06 years in Group-B. Mean procedure time was noted to be 0.91±0.35 hours in Group-A and 1.38±0.25 hours in Group-B (p&lt;0.001). All cases were found to have satisfactory wound condition and bony union. Decrease in range of motion of elbow as 0-50, 6-100,and 11-150 in 10, 9 and 2 cases in Group-A respectively in comparison to 4, 14 and 3 cases in Group-B respectively (p=0.145). Functional outcome in 33.3% cases was excellent, good in 54.8% and fair in 11.9% cases while there was no difference in between both study groups (p=0.145). Conclusion: There is no significant difference in functional outcomes of early or late presentation in children undergoing open reduction and internal fixation for supracondylar fractures. Keywords: Supracondylar fracture, Humerus, Children, Early presentation, Late presentation, Open reduction, Internal fixation, K-wire stablization, Functional outcome.

Impact of post-operative hip-knee-ankle angle changes on functional outcome of total knee arthroplasty: a prospective longitudinal study

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Coronal malalignment as residual varus may have deleterious effects on functional outcomes of total knee arthroplasty. This study aimed at highlighting the impact of postoperative hip-knee-ankle (HKA) angle changes on the functional outcome of total knee arthroplasty.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;689 total knee arthroplasty (TKA) knees (from 386 patients) with varus postoperative HKA angle were included. HKA angle was measured on standing orthoscanograms. The knees were divided into 5 subgroups according to postoperative HKA angle as: neutral (0±3.0 degrees); mild (3.1-6.0 degrees); moderate (6.1-10.00 degrees); severe (10.1-5.0 degrees); very severe (&amp;gt;15.0 degrees). Functional outcome of TKA in these subgroups was observed by knee society score (KSS), knee society pain score (KSS-P), Oxford knee score (OKS), lower extremity functional scale (LEFS) at 6 months, 1 year, 2 years, 3 years. Statistical analysis was done by statistical package for social sciences (SPSS) version 16; Spearman’s correlation coefficient and Kruskall Wallis test was used to compare the functional outcome of TKA between COHORTs.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 69 knees were present in the mild varus cohort (mean: -1.92), 223 knees in the moderate varus COHORT (mean: -4.77), 260 knees in the moderate varus COHORT (mean: -7.86), 121 knees in the severe varus COHORT (mean: -11.60) and 16 knees in the very severe varus COHORT (mean: -16.54). Mild to moderate varus knees were maximum, but no significant difference in functional outcome between these COHORTs was found by correlation analysis and Kruskall Wallis test.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Changes in postoperative HKA angle (coronal alignment) has no significant impact on functional outcome of TKA.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;

Rural-urban differences in functional outcomes after acute stroke therapy within the stroke belt

IntroductionThe Southeastern United States (US) has the highest stroke mortality rate in the country. A high proportion of its population lives in rural areas. Rural patients with stroke have worse outcomes than their urban counterparts. We compared 90-day modified Rankin Score (mRS) between patients living in urban versus rural areas who received endovascular intervention for acute stroke. MethodsWe performed a retrospective analysis of patients who received acute stroke therapy at a comprehensive stroke center in the Southeastern US from 2014 to 2018. Individuals were classified as rural or urban dwellers based on 2010 Rural-Urban Commuting Area Codes. Stepwise logistic regression models were performed using clinical and demographic characteristics to compare good (mRS 0–1) vs poor (mRS 2–6) functional outcomes between urban and rural patients. Results232 patients were included (185 urban and 47 rural). Urban and rural groups had similar composition of age, gender, and proportion of African-Americans. Mean baseline NIH stroke scale was higher in rural patients (17.0 vs 14.8 respectively, p-value=0.03.). Our model for poor functional outcome at 90-days revealed only older age as a significant risk factor (OR 0.97, 95% CI 0.95–0.99). ConclusionsOur study found that for patients receiving acute therapy for ischemic stroke, there were no significant differences in functional outcome between urban versus rural patients. Only older age predicted poor functional outcome at 90 days. Our study demonstrates that patients from rural areas may not have worse mortality rates or poor outcomes and can recover similarly to those from urban areas.

Comparative clinical and radiographic outcomes between early and delayed wrist mobilization after volar fixed-angle plate fixation of distal radius fracture

Postoperative immobilization protocols after volar fixed-angle plate fixation of distal radius fractures (DRF) vary among surgeons. This study aimed to compare functional outcomes, radiographic parameters, and complications between early and delayed mobilization after volar fixed-angle plate fixation of DRF. This study is a randomized controlled trial. The early group was allowed to perform wrist motion exercise immediately after surgery and the delayed group was allowed to perform it after 2 weeks of external immobilization. Postoperative patient-rated wrist evaluation (PRWE), disabilities of arm, shoulder, and hand (DASH), wrist range of motion, visual analog scale (VAS) pain score, and grip strength were evaluated. Forty-eight patients with DRF were enrolled and randomly allocated to the early or delayed mobilization groups. The PRWE, DASH, VAS pain score, grip strength, and wrist motion of both groups significantly improved over time. However, there were no significant differences between groups at any timepoint. Radiographic parameters were not different between groups. There were no significant differences in functional outcomes, radiographic parameters, and complications between early and delayed mobilization after volar fixed-angle plate of DRF. Immediate postoperative wrist range-of-motion exercise can be safely initiated after volar fixed-angle plate fixation of DRF without external immobilization.Clinical trial registration: Thaiclinicaltrials.org identifier: TCTR20180927005. Registered 27/09/2018—retrospectively registered. https://www.thaiclinicaltrials.org/show/TCTR20180927005.

Double-Tunnel Technique Was Similar to Single-Tunnel Technique in Clinical, Imaging and Functional Outcomes for Medial Patellofemoral Ligament Reconstruction: A Randomized Clinical Trial

This study aimed to compare the clinical, functional, and imaging outcomes of single-tunnel (ST) and double-tunnel (DT) techniques for medial patellofemoral ligament (MPFL) reconstruction. Ninety-four patients with recurrent patellar instability were randomly divided into 2 groups, receiving either ST or DT MPFL reconstruction. Lateral reticulum release (LRR) and tibial tuberosity (TT) transfer were performed as combined procedures when necessary. Preoperative and postoperative clinical characteristics (symptoms and episodes of redislocation), functional outcomes (Kujala, Lysholm, Tegner, IKDC, and KOOS score), and radiological measurements (congruence angle, patellar tilt angle, lateral patellar angle, and lateral patellar translation) were analyzed. The analysis included data from 90 patients with 48 patients in the ST group and 42 patients in the DT group. Patients were followed up for a mean period of 37.8 (range: 27-50) months in the ST group and 38.6 (range: 25-53) months in the DT group. Forty-three patients in the ST group and 40 patients in the DT group received combined TT transfer, and all patients underwent LRR. At thelatestfollow-up, 1 patient in ST group experienced redislocation, while no patient in the DT group sustained clinical failure (P= .347). Imaging measurements decreased significantly to the normal range postoperatively. No significant difference was noted between the postoperative radiological results of the 2 groups. All clinical scores significantly improvedpostoperatively,and no significant difference was observed between the 2 groups except for the higher Lysholm score (P= .031), KOOS symptoms score (P= .021) and KOOS knee-related quality of life score (P= .043) in the DT group. Both techniques could equally mitigate the patellar lateral translation or redislocation. Our results demonstrate several significant differences in functional outcomes that favored DT MPFL reconstruction but no difference in clinical failure rates and radiological results between ST and DT MPFL reconstruction. Level I, randomized clinical trial.

The Local Intraarterial Administration of Nimodipine Might Positively Affect Clinical Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage and Delayed Cerebral Ischemia.

The effect of the intraarterial administration of nimodipine as a rescue measure to treat delayed vasospasm after aSAH remains understudied; therefore, we evaluated its effect on short- and long-term functional and neuropsychological outcomes after aSAH. In this prospective observational study, a total of 107 consecutive patients treated for aSAH of WFNS grades I–V were recruited. At follow-up visits 3-, 12- and 24-months after the hemorrhage, functional outcome was assessed using the Extended Glasgow Outcome (GOSE) and modified Rankin (mRS) scales, while neurocognitive function was evaluated using the screening module of the Neuropsychological Assessment Battery (NAB-S). The outcome of patients, who had received rescue therapy according to the local standard treatment protocol (interventional group, n = 37), and those, who had been treated conservatively (conservative group, n = 70), were compared. Even though significantly more patients in the interventional treatment group suffered from high-grade aSAH (WFNS Grades IV and V, 54.1% vs. 31.4%, p = 0.04) and required continuous drainage of cerebrospinal fluid at discharge (67.7% vs. 37.7%, p = 0.02) compared to the control group, significant differences in functional outcome were present only at discharge and three months after the bleeding (GOSE > 4 in 8.1% vs. 41.4% and 28.6% vs. 72.7%, p < 0.001 and p = 0.01 for the interventional and control group, respectively). Thereafter, group differences were no longer significant. While significantly more patients in the intervention group had severe neuropsychological deficits (76.3% vs. 36.0% and 66.7% vs. 29.2%, p = 0.04 and 0.05, respectively) and were unable to work (5.9% vs. 38.1%, p = 0.03 at twelve months) at three and twelve months after the hemorrhage, no significant differences between the two groups could be detected at long-term follow-up. The presence of moderate neuropsychological impairments did not significantly differ between the groups at any timepoint. In conclusion, despite initially being significantly more impaired, patients treated with intraarterial administration of nimodipine reached the same functional and neuropsychological outcomes at medium- and long-term follow-up as conservatively treated patients suggesting a potential beneficial effect of intraarterial nimodipine treatment for delayed vasospasm after aSAH.

Percutaneous k-wiring versus closed reduction and cast application for the management of extra-articular distal end radius fractures: A comparative study

Introduction: In extra-articular distal radius fractures, closed reduction and casting have been the mainstay of treatment, difficulty lies in predicting and maintaining the proper reduction at the final union. Percutaneous K-wire stabilization is also a widely accepted treatment option, but there is no consensus on its outcome compared to closed reduction and casting. Aim: To evaluate the results of closed reduction and casting versus closed reduction with percutaneous K wire fixation and casting in the treatment of the distal radius extra-articular fracture with reference to the restoration of radial height, radial inclination, a volar tilt of the distal articular surface and to assess the functional outcome of the same measured by the Gartland and Werley demerit scoring system. Materials and Methods: Prospective study was conducted on 60 patients attending the Department of Orthopaedics, from December 2013 to May 2015 with extra-articular fractures (AO type 23-A2 and 23-A3) of the distal radius and fulfilling all the inclusion and exclusion criteria. The cases were randomly divided into two equal groups of 30 patients, the first group was treated by closed reduction and below elbow cast application, while the second group was treated by closed reduction percutaneous K-wire application and below elbow cast application. The radiological outcome of both groups were evaluated by measuring the Volar inclination, Radial inclination and Radial height, while the functional outcome was evaluated by the demerit scoring system of Gartland and Werley.Results: The Cast application group had 13 excellent, 9 good, 7 fair and 1 poor result the mean outcome score of the group was 5.2. The K wiring group had 11 excellent, 13 good, 5 fair and 1 poor result, the mean score of the group was 5.17. The unpaired student’s t-test on the values obtained from both groups yielded a p-value of 0.9816. The mean radial height in the Cast application group was 8.033mm while the mean in the k wiring group was 11.783mm. The mean volar tilt was 4.867 degrees and 7.5 degrees respectively. The mean radial inclination was 14.23 degrees and 19.1respectively. Unpaired student’s t-test on the values revealed a p-value of 0.0001 for all three.Conclusion: We concluded that closed reduction with percutaneous K-wire fixation under C-arm for treatment of extra articular fractures of distal radius gives statistically significantly better radiological outcome than treatment with closed reduction and casting alone, but there is no statistically significant difference in functional outcome.

The impact of the COVID-19 pandemic on functional and mental health outcomes after trauma

BackgroundThe COVID-19 pandemic has led to decreased access to care and social isolation, which have the potential for negative psychophysical effects. We examine the impact of the pandemic on physical and mental health outcomes after trauma. MethodsPatients in a prospective study were included. The cohort injured during the pandemic was compared to a cohort injured before the pandemic. We performed regression analyses to evaluate the association between the COVID-19 pandemic and physical and mental health outcomes. Results1,398 patients were included. In adjusted analysis, patients injured during the pandemic scored significantly worse on the SF-12 physical composite score (OR 2.21; [95% CI 0.69–3.72]; P = 0.004) and were more likely to screen positive for depression (OR 1.46; [1.02–2.09]; P = 0.03) and anxiety (OR 1.56; [1.08–2.26]; P = 0.02). There was no significant difference in functional outcomes. ConclusionsPatients injured during the COVID-19 pandemic had worse mental health outcomes but not physical health outcomes.

Endovascular thrombectomy beyond 24 hours from ischemic stroke onset: a propensity score matched cohort study

BackgroundThe safety and functional outcome of endovascular thrombectomy (EVT) in the very late (VL; >24 hours) time window from ischemic stroke onset remains undetermined.MethodsUsing data from a national stroke registry,...

Cemented versus uncemented reverse shoulder arthroplasty for acute proximal humeral fractures.

The purposes of this study were (1) to compare postoperative range of motion (ROM) and functional outcomes in patients with proximal humeral fractures operated on with cemented or uncemented reverse shoulder arthroplasty (RSA), (2) to compare the rate of tuberosity healing between cemented and uncemented stems, (3) to determine whether there are significant differences in functional outcomes between patients with healed tuberosities and those with unhealed tuberosities, and (4) to compare complications and revision rates in patients with cemented RSA and uncemented RSA. A cemented RSA was performed early in the study period, which represented a historical cohort (January 2015 to January 2017), followed by a transition to the uncemented RSA later in the study period (February 2017 to February 2019). We excluded 22 cases from postoperative evaluation because of fracture sequelae, age < 65 years, death, and institutionalization; 3 patients were lost to follow-up. The remaining 67 cases (32 cemented and 35 uncemented) underwent clinical and radiographic evaluation by 2 independent fellowship-trained shoulder surgeons. Patients were assessed regarding ROM and the visual analog scale for pain, American Shoulder and Elbow Surgeons score, Constant score, and Single Assessment Numeric Evaluation score. All intraoperative and postoperative complications were recorded. The mean follow-up period was 41 months (range, 24-72 months), and the mean age was 74 years (range, 65-84 years). Mean postoperative active elevation, internal rotation, external rotation in abduction, and external rotation in adduction were 130° (±15°), 27° (±5°), 28° (±10°), and 16° (±6°), respectively. The mean postoperative visual analog scale, American Shoulder and Elbow Surgeons, Constant, and Single Assessment Numeric Evaluation scores were 1.8 (±0.8), 74 (±6), 58 (±11), and 74% (±8), respectively. There were no significant differences in final ROM and functional scores between the cemented and uncemented groups. The rate of tuberosity healing did not vary significantly in relation to whether the stem was cemented. The subgroup of patients with tuberosity healing presented significantly better active elevation, external rotation, and Constant scores than the subgroup without tuberosity healing. There were 5 complications (7%) and no cases of aseptic humeral stem loosening. In the short term (mean, 41 months), there were no significant differences in postoperative ROM, functional outcomes, complications, and revisions between patients operated on with cemented RSA and those operated on with uncemented RSA for proximal humeral fractures. Patients with healed tuberosities presented significantly better ROM and functional scores than patients without tuberosity healing. The cementation of the stem did not significantly affect the rate of tuberosity healing.

Thrombectomy in basilar artery occlusion.

The benefit of thrombectomy (TE) for acute ischemic stroke (AIS) in patients suffering basilar artery occlusion (BAO) is still unclear. Our aim was to analyze functional outcome after 3 months in BAO compared to anterior circulation large vessel occlusion (ACLVO) in a nationwide registry. Patients enrolled into the Austrian Endostroke Registry from 2013 to 2018 were analyzed. We used propensity score matching to control for imbalances and to compare patients with BAO and ACLVO. The primary outcome was favorable functional outcome after 3 months measured by the modified Rankin Scale (mRS) (0-2). Multivariate models were applied to estimate the effect of localization (BAO vs ACLVO). In total, 2288 patients underwent TE for AIS with proximal vessel occlusion, of these 267 with BAO. Two hundred and sixty-four patients with BAO were matched to 264 patients with ACLVO. Baseline characteristics were well-balanced. The 90-day mortality did not significantly differ between patients with BAO and ACLVO. In a multivariate logistic regression model, we did not detect a significant difference in functional outcome between BAO and ACLVO (odds ratio for favorable outcome defined as mRS = 0-2: 1.19; 95% confidence interval (CI) = 0.78-1.81; p = 0.42). In patients with an onset-to-door-time ⩾270 min, TE of BAO was associated with poor functional outcome defined as mRS 3-6 (odds ratio (OR) = 3.97; 95% CI = 1.32-11.94; p = 0.01) as compared to ACLVO. In this study, functional outcome did not differ after TE in patients with BAO and ACLVO overall; however, we detected an association of BAO with poor outcome in patients arriving late.

Comparative Studies of Cerebral Reperfusion Injury in the Posterior and Anterior Circulations After Mechanical Thrombectomy

Cerebral reperfusion injury is the major complication of mechanical thrombectomy (MT) for acute ischemic stroke (AIS). Contrast extravasation (CE) and intracranial hemorrhage (ICH) are the key radiographical features of cerebral reperfusion injury. The aim of this study was to investigate CE and ICH after MT in the anterior and posterior circulation, and their effect on functional outcome. This is a retrospective study of all consecutive patients who were treated with MT for AIS at University of California Irvine Medical Center between January 1, 2014, and December 31, 2017. Patient characteristics, clinical features, procedural variables, contrast extravasation, ICH, and outcomes after MT were analyzed. A total of 131 patients with anterior circulation (AC) stroke and 25 patients with posterior circulation (PC) stroke underwent MT during the study period. There was no statistically significant difference in admission NIHSS score, blood pressure, rate of receiving intravenous tPA, procedural variables, contrast extravasation, and symptomatic ICH between the 2 groups. Patients with PC stroke had a similar rate of favorable outcome (mRS 0–2) but significantly higher mortality (40.0% vs. 10.7%, p < 0.01) than patients with AC stroke. Multivariate regression analysis identified initial NIHSS score (OR 1.1, CI 1.0–1.2, p = 0.01), number of passes with stent retriever (OR 2.1, CI 1.3–3.6, p < 0.01), and PC stroke (OR 9.3, CI 2.5–35.1, p < 0.01) as independent risk factors for death. There was no significant difference in functional outcomes between patients with and without evidence of cerebral reperfusion injury after MT. We demonstrated that AC and PC stroke had similar rates of cerebral reperfusion injury and favorable outcome after MT. Cerebral reperfusion injury is not a significant independent risk factor for poor functional outcome.

Dynamic Compression Plate versus Locking Compression Plate Fixation in Adult Forearm Fractures: A Prospective Interventional Study

Introduction: Injuries resulting from traffic accidents, industrial accidents, natural disasters, and assault are the cause of most fractures of the forearm and it is very important to regain the length, apposition, axial alignment, and rotational alignment of the radius and ulna while treating diaphyseal fractures to achieve a good range of motion. In such cases, open reduction and internal fixation are recommended. Aim: To determine the effectiveness of Locking Compression Plates (LCP) and Dynamic Compression Plates (DCP) in treating adult forearm fractures. Materials and Methods: A prospective interventional study was conducted from September 2020 to September 2021 in which 30 patients with both bone forearm fractures underwent open reduction and internal fixation with a Locking Compression Plate(n=15) or a Dynamic Compression Plate(n=15) at the Dr.D.Y. Patil Medical College, Hospital and Research Centre, Pimpri, Pune, India. For each LCP and DCP operated patient, radiographic findings regarding fracture union and functional outcomes regarding elbow joint range of motion was evaluated. Appropriate parametric tests (Chi-square test, Independent t-test) were conducted to identify significant differences in functional outcomes between the two interventions. Results: Out of total, 13 patients (86.7%) each who underwent both the DCP and LCP fixation had excellent outcomes, though the results were not significant according to Anderson LD et al., grading system. Although it was statistically insignificant (p-value= 0.18), patients who received LCP took less time to heal their fractures than those who received DCP. There was no significant difference between patients treated with DCP and those treated with LCP when it comes to achieving a complete range of motion (p-value=0.99). Conclusion: In terms of functional outcome, both the patient groups who were operated on with DCP as well as LCP had no significant difference. Proper preoperative planning, good patient care, proper surgical technique with minimal adjacent soft tissue damage, strict aseptic conditions, proper follow-up, and rehabilitation along with patient education are all required for good functional outcomes.

Functional outcome of infected endoprosthesis: A 20-year retrospective analysis.

Bone tumours are increasingly treated with limb-salvage surgeries. However, implant infection is a devastating complication, greatly affecting the functional outcome. Yet, data on functional outcome post-implant infection are scarce. This study aims to determine the functional outcome and implant survival of these patients. Patients' data on endoprosthetic replacement surgeries at our institution (January 1996-December 2016) was retrospectively reviewed. Information was available for 161 patients and was analysed using SPSS and SMART Partial Least Squares. Functional outcome was determined using the Musculoskeletal Tumor Society (MSTS) and Toronto Extremity Salvage Score (TESS) scoring system. Both mean rank MSTS (33.14 vs 87.02) and TESS (48.17 vs 85.13) scores were significantly lower in the infected group. These differences remained statistically significant after excluding amputation and rotationplasty cases within the infected group. Even after the resolution of infection, both MSTS and TESS remained significantly higher in the non-infected group. However, analysis of the infected group showed no significant differences in functional outcome between persistent and resolved infections (implant in-situ). Age significantly impacted the functional outcome for both the non-infected and infected groups, while local recurrence and metastasis significantly impacted the non-infected cases. Local tumour recurrence was lower in infected endoprosthetic patients (8.3% vs 10.5%). 56% of infected implants were removed; the majority were treated with two-stage revision surgery. Endoprosthesis infection worsens the overall functional outcome. Additional factors affecting functional outcome were age, presence of local recurrence and metastatic disease. Local tumour recurrence was lower amongst infected endoprosthesis cases, and >50% of infected implants were removed.

Functional Outcome of Anterior Cruciate Ligament Reconstruction by Tibial Attachment Preserving versus Sacrificing Hamstring Graft Technique- A Prospective Interventional Study

Introduction: Anterior Cruciate Ligament (ACL) is a stout, short intra-articular, extra synovial structure. For a knee with the deficiency of ACL, the ligament reconstruction using an autograft, either a free bone patellar tendon bone graft or a Semi Tendinosus and Gracilis (STG) tendon free hamstring graft, is the most common surgical treatment. Tibial fixation region of the graft is presumed to be a delicate point in arthroscopic ACL reconstruction. There, can be a chance of graft pull out from the tibial tunnel before actual healing of the graft– tunnel can occur. To avoid this problem, the technique of tibial attachment preserved hamstring graft can be used instead of free hamstring graft. Aim: To evaluate and compare the functional outcome of patients who underwent ACL reconstruction with either a free hamstring graft or by tibial attachment preserving hamstring graft. Materials and Methods: A prospective interventional study was conducted in the Department of Orthopaedics, Swami Rama Himalayan University Hospital, Dehradun, Uttarakhand, India, over a period of one year (July 2019-July 2020). A total 52 patients were included and they were divided into two groups. Group A (tibial attachment preserving hamstring graft) and Group B (tibial attachment sacrificing hamstring graft) with each group comprised 26 patients. Patients were assessed with Lysholm score at 6, 12 and 24 weeks of follow-up. For determining the statistical difference between the two groups Independent Student’s t-test was used, whereas for more than two groups Analysis of Variance (ANOVA) test was used and a p-value &lt;0.05 was considered to be significant. Results: The mean age of patients in group A was 30.73±10.02 years whereas in group B it was 29.54±9.84 years. For group A, mean Lysholm score at 6 weeks was 73.23±8.37, at 12 week score was 86.85±5.93 and at 24 week score was 95.58±4.91. For group B, mean Lysholm score at 6 weeks was 74.15±5.82, at 12 weeks score was 87.46±5.95 and at 24 weeks score was 96.92±3.61. Post-hoc analysis showed that there was a significant difference in mean Lysholm score {between preoperative and other time points (p&lt;0.001, respectively)} for both the groups but there was no significant difference in Lysholm score at 6 weeks (p=0.646), 12 weeks (p=0.710) and 24 weeks (p=0.265) when compared between the two groups. Conclusion: ACL reconstruction using hamstring autograft with preserved tibial insertion resulted in no statistically significant difference in functional outcome as compared with free autograft.

Is the operative treatment of displaced diaphyseal forearm fractures in children superior to non-operative treatment? A systematic review of functional outcomes and complications

Background: There has been a rising tendency towards surgical intervention for diaphyseal forearm fractures in children in recent years; however, the literature lacks robust evidence for this. The aim of this systematic review was to identify and critically analyse studies examining the functional outcomes and complications of operative versus non-operative treatments for these common injuries. Materials and Methods: A literature search was performed, using MEDLINE, EMBASE, PubMed, Cochrane Central databases and Google Scholar for relevant articles published between January 2005 and December 2015. Results: 253 studies were identified, of which 23 met the rigorous inclusion and exclusion criteria. No significant differences in functional outcomes between the treatment groups were reported by any of the studies. There was a 21.4% complication rate with operative treatment and a 7.2% complication rate with non-operative treatment. Conclusion: This systematic review demonstrates that there is an increasing tendency towards operative management over non-operative treatment during the last decade, especially in older children and adolescents.

Anterior inferior plating versus superior plating for middle 1/3rd clavicle fracture: a prospective comparative study

&lt;p class="abstract"&gt;&lt;strong&gt;Background: &lt;/strong&gt;Fractures of the clavicle are common injuries that may result from direct blow or transmitted forces. Deformities are shortening and depression of lateral fragments. Various techniques are performed out of which superior and anteroinferior plating are widely used with each having its own merits and drawbacks. Our study compares the outcome between above mentioned techniques.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We conducted a prospective comparative study of 60 patients who has met inclusion criteria and out of which 30 patients were treated with anteroinferior technique and 30 patients were treated with superior plating technique. Outcome measure were assessed through constant and murley score.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results: &lt;/strong&gt;The demographic analysis of our study showed that the incidence of fracture is predominant among males (63.3%) with RTA being the most common mode of injury. AO/OTA classification which was used in our study revealed A1 as the most frequently involved group. Each group had 2 patients with infection post operatively which was managed with appropriate antibiotics. Increased incidence of delayed union was found in anterioinferior group (13.3%) with decreased hardware prominence in comparison with superior plating.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; There were no significant differences in functional outcome between both the groups except the fact that superior plating had higher chances of plate prominence. So either of the surgical technique can be employed depending upon the feasibility of surgeon.&lt;/p&gt;