Ankle fractures have an incidence of around 90,000 per year in the United Kingdom. They affect younger patients following high energy trauma and, in the elderly, following low energy falls. Younger patients with pre-existing comorbidities including raised BMI or poor bone quality are also at risk of these injuries which impact the bony architecture of the joint and the soft tissues leading to a highly unstable fracture pattern, resulting in dislocation. At present, there is no literature exploring what effect ankle fracture-dislocations have on patients’ quality of life and activities of daily living, with only ankle fractures being explored. Relevant question formatting was utilised to generate a focused search. This was limited to studies specifically mentioning ankle injuries with a focus on ankle fracture-dislocations. The number of patients, fracture-dislocation type, length of follow up, prognostic factors, complications and outcome measures were recorded.Abstract
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To determine the number of patients with low back pain who have low serum Vitamin-D levels in our local population and the clinical efficacy of Vitamin-D supplementation on VAS and MODQ scores This Prospective cohort study was conducted from 20th March 2016 to 19th March 2017. 600 patients were included in the study who met the inclusion criteria, i.e. patients presenting to the Out Patient Department (OPD) with low back pain for a duration of less than six months aged between 15 to 55 years. Venous blood withdrawn and serum levels of Vitamin-D measured. According to serum Vitamin-D levels, categorized as deficient, sufficient or excess. Those having deficient Vitamin-D levels (< 2 0 ng/dL) were given Vitamin-D supplementation as Oral 50,000 IU Vitamin-D3 daily for 05 days, then once weekly for 08 weeks while those having insufficient levels (20–30 ng/dL) given Oral 50,000 IU Vitamin-D3 once weekly for 08 weeks. Vitamin-D levels, Visual Analog Pain Scale (VAS) and Modified Oswestry Disability Questionnaire (MODQ) scoring done at baseline, 02, 03 and 06 months. Data analyzed using SPSS version 23. Mean age of patients included in the study 44.21 ± 11.92 years. Out of the total, 337 (56.17%) were males and 263 (43.83%) females. Out of the total, 20.67%, 26.17% and 28.83% had mild, moderate and severe Vitamin-D deficiency, respectively. Predominantly patients with severe Vitamin-D deficiency presented in winters (October – February) (17.16%) as compared to other seasons. The most pre-dominant risk factor in patients with low Vitamin-D levels was smoking (21.33%). Mean baseline Vitamin-D levels were 13.32 ± 6.10 ng/dL and after supplementation these levels improved to 37.18 ± 11.72 ng/dL. VAS score improved from a mean baseline value to 81 to 36 at 6 months (p < 0 .01). Likewise, MODQ score decreased from a baseline mean of 46 to 25 at 6 months (p < 0 .01) Vitamin D plays a crucial role in the musculoskeletal framework of the body. The deficiency is more prevalent in the youth due to sedentary lifestyle and indoor preference. Improvement in pain & functional disability with Vitamin-D supplementation For any reader queries, please contact
To compare the efficacy of intra-articular and intravenous modes of administration of tranexamic acid in primary Total Knee Arthroplasty in terms of blood loss and fall in haemoglobin level. This randomized controlled trial was conducted from 12th May 2017 to 11th May 2017. Seventy eight patients were included in the study. Patients were randomly divided into group A and B. Group A patients undergoing unilateral primary total knee replacement (TKR) were given intravenous tranexamic acid (TXA) while group B were infiltrated with intra-articular TXA. Volume of drain output, fall in haemoglobin (Hb) level and need for blood transfusion were measured immediately after surgery and at 12 and 24 hours post operatively in both groups. The study included 35 (44.87%) male and 43 (55.13%) female patients. Mean age of patients was 61±6.59 years. The mean drain output calculated immediately after surgery in group A was 45.38±20.75 mL compared with 47.95±23.86 mL in group B (p=0.73). 24 hours post operatively, mean drain output was 263.21±38.50 mL in intravenous group versus 243.59±70.73 mL in intra-articular group (p=0.46). Regarding fall in Hb level, both groups showed no significant difference (p>0.05). 12.82% (n=5) patients in group A compared to 10.26% (n=4) patients required blood transfusion post operatively (p=0.72). Intra-articular and intravenous TXA are equally effective in patients undergoing primary total knee arthroplasty in reducing post operative blood loss. For any reader queries, please contact
To determine the effect of Dexamethasone on post-operative pain management in patients undergoing Total Knee Arthroplasty in terms of numerical pain rating scale and total opoid consumption. This Randomized Controlled Trail (RCT) was conducted for 02 years (7th September 2015 to 6th September 2017). All patients undergoing primary Unilateral Total Knee Replacement (TKR) for Osteoarthritis knee were included in the study. Patients with poor glycemic control (HbA1c > 7.6), Hepatic/Renal failure, corticosteroids/ Immunosuppression drug usage in the last 06 months, known psychiatric illnesses were excluded from the study. All patients were operated by consultant Orthopaedic surgeon under Spinal Anaesthesia and tourniquet control using medial para-patellar approach. Patients were randomly divided into 02 groups, A and B. 79 patients were placed in each group. Group A given 0.1mg/kg body weight Dexamethasone Intravenously 15 minutes prior to surgery and another dose 24 hours post-operatively while in group B (control group) no Dexamethasone given. Post-operative pain using the numerical pain rating scale (NRS) and total narcotics consumed converted to morphine dose equivalent noted immediately post-op, 12-, 24- and 48-hours post-operatively. Data analysis done using SPSS version 23. A total of 158 patients were included in the study. Of the total, 98 (62.02%) were females and 60 (37.98%) males. Average BMI of patients 26.94 ±3.14 kg/m2. Patients in group A required less post-operative analgesics (p < 0 .01) and had a better numerical pain rating scale score (p < 0 .01) as compared to group B. Pain scores at 24- and 48-hours post-op were significantly less for Dexamethasone group (p < 0 .01). Use of Dexamethasone per- and post-operatively reduces the pain and amount of analgesics used in patients undergoing TKA. For any reader queries, please contact
Thirty five patients who underwent surgical correction of a degenerative scoliosis were identified. The pre-operative standing antero-posterior radiographs were compared with the coronal MRI images and Cobb angles measured. The mean patient age was 64 years old. The mean increase in Cobb angle in the degenerative curve on standing was ten degrees. This was not associated with age or magnitude of curve. A degenerative scoliosis is often considered inflexible. These results show that such curves do retain some flexibility and therefore patients may present with dynamic symptoms not represented on supine MRI images. Furthermore, pre-operative supine radiographs will identify the degree of flexibility that can be expected intra-operatively.
