BACKGROUND Spinal cord injury(SCI)imposes enduring physical impairments and substantial socio-economic burdens.These injuries are either traumatic incidents or ischemic but exhibit comparable clinical recoveries.This ...BACKGROUND Spinal cord injury(SCI)imposes enduring physical impairments and substantial socio-economic burdens.These injuries are either traumatic incidents or ischemic but exhibit comparable clinical recoveries.This suggests shared underlying neurodegenerative mechanisms,such as neuronal cell death,demyelination,and axonal degeneration,regardless of aetiology.AIM To investigate the relationship between the magnetic resonance imaging(MRI)biomarkers(tissue bridges)and clinical outcome in acute traumatic SCI.METHODS In this prospective study adult patients with acute SCI who were examined clinically and radiologically within first 48 hours and subsequently at intervals were included.Clinical assessment included sensory score,motor score and zone of partial preservation.Radiological scores included measurement kyphotic deformities-sagittal index,regional kyphosis,gardener segmental kyphotic deformity.MRI on 3 Tesla machine was done to evaluate quantitative&qualitative parameters,and tissue bridges at one and 6 months.RESULTS There were 47 patients with a mean age of 40.43±10.73 years and male/female ratio of 34:13.There was a significant(P<0.05)improvement in clinical,radiological,and MRI parameters at 6 months.Maximum spinal cord compression(MSCC),maximal canal compression,lesion length,width,and area;dorsal tissue bridges;ventral tissue bridges,total width of tissue bridges;and midsagittal tissue bridge ratios at one month significantly(P<0.05)correlated with the 6-month total motor score and total sensory score.Further,the regression analysis demonstrated clinical improvement to dimensions of tissue bridges at 6 months.CONCLUSION The MRI imaging biomarkers in SCI patients demonstrated substantial improvement over time.There was a negative correlation between neurological recovery,MSCC,maximum canal compromise,and lesion dimensions(lesion length,lesion width,and lesion area).Higher canal compromise and lesion dimensions were associated with a poorer outcome.The evaluation of the midsagittal tissue bridge(including the ventral tissue bridge,dorsal tissue bridge,total width of the tissue bridge,and tissue bridge ratios)at 1 and 6 months showed a positive correlation with the neurological recovery.展开更多
Purpose:Distal femoral fracture is one of the most common lower limb injuries and accounts for less than 1%of all fractures.Open fracture takes 5%-10%of the all distal femoral fractures,which is at an increased risk o...Purpose:Distal femoral fracture is one of the most common lower limb injuries and accounts for less than 1%of all fractures.Open fracture takes 5%-10%of the all distal femoral fractures,which is at an increased risk of complications.There were limited studies which documented the outcomes of such cases.The present study aims to evaluate the outcome and complications in these fractures using primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement.Methods:This is a prospective study conducted in a tertiary care orthopaedic hospital in northern India.Thirty patients of open distal femoral fractures were managed by primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement.They were followed for minimum of six months.Patients were followed up monthly for first four months,at six months and one year after surgery.Clinical and radiological signs of healing,any complications,time to union,and functional outcome were assessed.Results:The mean age of patients was 44.33 years(range 20-82 years)with male predominance of 66.7%.According to Gustilo-Anderson classification,there were 5,15 and 10 patients with open grade I,II and IIIA distal femoral fractures respectively.According to orthopaedic trauma association(OTA)classification,majority of patients in our study were of C3 type.The mean time to bony union was 5.6 months(range 4-9 months).Average postoperative knee range of motion(ROM)at the latest follow-up was 98°(range 70°-120°).Lysholm knee scoring scale showed excellent score in 11 patients,good in 9 patients,fair and poor in 5 patients each;however,there was no significant correlation with fracture pattern types(p<0.05).Knee stiffness was the major complications encountered in the study.The knee ROM was<90°in 5 patients and 90°-120°in rest of the patients,while 1 patient had extensor lag of 10°.One patient had implant failure and lost to follow-up;3 patients had deep infection.Conclusion:An approach of primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to early aggressive debridement in open distal femur fractures shows significant results in terms of functional and radiological outcomes with minimal complications.展开更多
Purpose： New research is focusing on the use of autologous growth factors to increase the effect of bone fracture healing while decreasing the amount of healing time for the patient. Platelets have been demonstrated ...Purpose： New research is focusing on the use of autologous growth factors to increase the effect of bone fracture healing while decreasing the amount of healing time for the patient. Platelets have been demonstrated to be the natural storage vessel for several growth factors and cytokines that promote blood coagulation, tissue repair, and the process of bone mineralization. The present study aims to evaluate the role of platelet-rich plasma （PRP） in healing of acute femoral shaft fractures radiologically. We hypothesize that it provides artificial hematoma and releases various growth factors. Methods： This prospective randomized study was carried out in 72 patients of traumatic fracture of the femoral shaft operated with interlocking nails （closed or open）. Patients were divided into two groups： study group A （n - 33） treated with intramedullary nailing ＆ PRP injection/gel application in the same setting; and control group B （n - 39） treated with intramedullary nailing without PRP application. Both groups were further divided into two subgroups. Study group included subgroup AI （n = 14） operated with closed intTamedullary nailing and PRP injection at the fracture site under radiological control, and subgroup A2 （n = 19） operated with open intramedullary nailing and PRP gel along with fibrin membrane application at the fracture site; while control group included subgroup B1 （n - 16） operated with closed intramedullary nailing, and subgroup B2 （n -- 23） operated with open intramedullary nailing. Radiological assessment of fracture healing was done by measuring the cortex to callus ratio every month till union at 6 months. Results： Measurements of mean cortex to callus ratio revealed significant difference between the groups A ＆ B at third and fourth months. Measurements of mean cortex to callus ratio did not reveal significant difference between the subgroups at first and sixth months. A statistically significant difference was observed between subgroups A1 ＆ B2 and B1 ＆ B2 at the second month; between subgroups A1 ＆ B2, A2 ＆ B2 and BI ＆ B2 at the third month; and between subgroups A1 ＆ B2 at fourth and fifth months. Conclusion： PRP has no effect on femoral shaft fracture healing treated with closed intramedullary nailing. However, PRP and matrix scaffold provided by fibrin membrane may provide an artificial he- matoma effect in the initial phase of healing in open or failed closed intramedullarv nailing.展开更多
Objective： Tibial shaft fractures are straightforward to treat but when associated with soft tissue injury particularly at the nail entry/plate insertion site or there is significant comminution proximally or a large...Objective： Tibial shaft fractures are straightforward to treat but when associated with soft tissue injury particularly at the nail entry/plate insertion site or there is significant comminution proximally or a large butterfly fragment/a second split component in the posterior coronal plane, it is a challenge to the treating surgeon. The aim of the present report is to describe the technique of posterior coronal plating in such a scenario and its ad- vantages. Methods： Between July 2008 and June 2011, 12 patients were prospectively treated by this approach using 4.5 mm broad dynamic compression plates. Results： The time of bony consolidation and full weight bearing averaged 21.7 weeks （range, 16-26 weeks）. Patients were followed up for at least 24 months （range, 24-48 months）. At 1 year postoperatively, no loss in reduction or alignment was observed. Mean Hospital for Lower Extremity Measurement Functional Score was 72.8 （range, 64-78）. All patients were satisfied with their treatment outcomes. Conclusion： Direct posterior approach and fixation using prone position helps to visualise the fracture fragments and provide rigid fixation. The approach is simple and extensile easily, apart from advantages of less soft tissue and hardware problems compared to standard medial or lateral plating.展开更多
文摘BACKGROUND Spinal cord injury(SCI)imposes enduring physical impairments and substantial socio-economic burdens.These injuries are either traumatic incidents or ischemic but exhibit comparable clinical recoveries.This suggests shared underlying neurodegenerative mechanisms,such as neuronal cell death,demyelination,and axonal degeneration,regardless of aetiology.AIM To investigate the relationship between the magnetic resonance imaging(MRI)biomarkers(tissue bridges)and clinical outcome in acute traumatic SCI.METHODS In this prospective study adult patients with acute SCI who were examined clinically and radiologically within first 48 hours and subsequently at intervals were included.Clinical assessment included sensory score,motor score and zone of partial preservation.Radiological scores included measurement kyphotic deformities-sagittal index,regional kyphosis,gardener segmental kyphotic deformity.MRI on 3 Tesla machine was done to evaluate quantitative&qualitative parameters,and tissue bridges at one and 6 months.RESULTS There were 47 patients with a mean age of 40.43±10.73 years and male/female ratio of 34:13.There was a significant(P<0.05)improvement in clinical,radiological,and MRI parameters at 6 months.Maximum spinal cord compression(MSCC),maximal canal compression,lesion length,width,and area;dorsal tissue bridges;ventral tissue bridges,total width of tissue bridges;and midsagittal tissue bridge ratios at one month significantly(P<0.05)correlated with the 6-month total motor score and total sensory score.Further,the regression analysis demonstrated clinical improvement to dimensions of tissue bridges at 6 months.CONCLUSION The MRI imaging biomarkers in SCI patients demonstrated substantial improvement over time.There was a negative correlation between neurological recovery,MSCC,maximum canal compromise,and lesion dimensions(lesion length,lesion width,and lesion area).Higher canal compromise and lesion dimensions were associated with a poorer outcome.The evaluation of the midsagittal tissue bridge(including the ventral tissue bridge,dorsal tissue bridge,total width of the tissue bridge,and tissue bridge ratios)at 1 and 6 months showed a positive correlation with the neurological recovery.
文摘Purpose:Distal femoral fracture is one of the most common lower limb injuries and accounts for less than 1%of all fractures.Open fracture takes 5%-10%of the all distal femoral fractures,which is at an increased risk of complications.There were limited studies which documented the outcomes of such cases.The present study aims to evaluate the outcome and complications in these fractures using primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement.Methods:This is a prospective study conducted in a tertiary care orthopaedic hospital in northern India.Thirty patients of open distal femoral fractures were managed by primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to aggressive debridement.They were followed for minimum of six months.Patients were followed up monthly for first four months,at six months and one year after surgery.Clinical and radiological signs of healing,any complications,time to union,and functional outcome were assessed.Results:The mean age of patients was 44.33 years(range 20-82 years)with male predominance of 66.7%.According to Gustilo-Anderson classification,there were 5,15 and 10 patients with open grade I,II and IIIA distal femoral fractures respectively.According to orthopaedic trauma association(OTA)classification,majority of patients in our study were of C3 type.The mean time to bony union was 5.6 months(range 4-9 months).Average postoperative knee range of motion(ROM)at the latest follow-up was 98°(range 70°-120°).Lysholm knee scoring scale showed excellent score in 11 patients,good in 9 patients,fair and poor in 5 patients each;however,there was no significant correlation with fracture pattern types(p<0.05).Knee stiffness was the major complications encountered in the study.The knee ROM was<90°in 5 patients and 90°-120°in rest of the patients,while 1 patient had extensor lag of 10°.One patient had implant failure and lost to follow-up;3 patients had deep infection.Conclusion:An approach of primary definitive fixation with condylar locking plate and antibiotic impregnated collagen sheet secondary to early aggressive debridement in open distal femur fractures shows significant results in terms of functional and radiological outcomes with minimal complications.
文摘Purpose： New research is focusing on the use of autologous growth factors to increase the effect of bone fracture healing while decreasing the amount of healing time for the patient. Platelets have been demonstrated to be the natural storage vessel for several growth factors and cytokines that promote blood coagulation, tissue repair, and the process of bone mineralization. The present study aims to evaluate the role of platelet-rich plasma （PRP） in healing of acute femoral shaft fractures radiologically. We hypothesize that it provides artificial hematoma and releases various growth factors. Methods： This prospective randomized study was carried out in 72 patients of traumatic fracture of the femoral shaft operated with interlocking nails （closed or open）. Patients were divided into two groups： study group A （n - 33） treated with intramedullary nailing ＆ PRP injection/gel application in the same setting; and control group B （n - 39） treated with intramedullary nailing without PRP application. Both groups were further divided into two subgroups. Study group included subgroup AI （n = 14） operated with closed intTamedullary nailing and PRP injection at the fracture site under radiological control, and subgroup A2 （n = 19） operated with open intramedullary nailing and PRP gel along with fibrin membrane application at the fracture site; while control group included subgroup B1 （n - 16） operated with closed intramedullary nailing, and subgroup B2 （n -- 23） operated with open intramedullary nailing. Radiological assessment of fracture healing was done by measuring the cortex to callus ratio every month till union at 6 months. Results： Measurements of mean cortex to callus ratio revealed significant difference between the groups A ＆ B at third and fourth months. Measurements of mean cortex to callus ratio did not reveal significant difference between the subgroups at first and sixth months. A statistically significant difference was observed between subgroups A1 ＆ B2 and B1 ＆ B2 at the second month; between subgroups A1 ＆ B2, A2 ＆ B2 and BI ＆ B2 at the third month; and between subgroups A1 ＆ B2 at fourth and fifth months. Conclusion： PRP has no effect on femoral shaft fracture healing treated with closed intramedullary nailing. However, PRP and matrix scaffold provided by fibrin membrane may provide an artificial he- matoma effect in the initial phase of healing in open or failed closed intramedullarv nailing.
文摘Objective： Tibial shaft fractures are straightforward to treat but when associated with soft tissue injury particularly at the nail entry/plate insertion site or there is significant comminution proximally or a large butterfly fragment/a second split component in the posterior coronal plane, it is a challenge to the treating surgeon. The aim of the present report is to describe the technique of posterior coronal plating in such a scenario and its ad- vantages. Methods： Between July 2008 and June 2011, 12 patients were prospectively treated by this approach using 4.5 mm broad dynamic compression plates. Results： The time of bony consolidation and full weight bearing averaged 21.7 weeks （range, 16-26 weeks）. Patients were followed up for at least 24 months （range, 24-48 months）. At 1 year postoperatively, no loss in reduction or alignment was observed. Mean Hospital for Lower Extremity Measurement Functional Score was 72.8 （range, 64-78）. All patients were satisfied with their treatment outcomes. Conclusion： Direct posterior approach and fixation using prone position helps to visualise the fracture fragments and provide rigid fixation. The approach is simple and extensile easily, apart from advantages of less soft tissue and hardware problems compared to standard medial or lateral plating.
