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Sharma H.,Institute of Medical science | Khare G.N.,Institute of Medical science | Singh S.,Institute of Medical science | Ramaswamy A.G.,SMIMS | And 2 more authors.
Journal of Orthopaedic Science | Year: 2014

Objectives: Management of AO type B and C fractures of the distal radius is controversial. This study compares outcomes and complications of AO type B and C fractures of the distal radius treated with volar locked plating and nonoperative methods. Materials and methods: Sixty-four patients with fractures of the distal radius (AO type B and C) were included in this study, according to inclusion criteria, and were allocated to the volar plating group or nonoperative group by alternate randomization: 32 patients with odd numbers went into the nonoperative group and the other 32 with even numbers went into the volar plating group. Patients in the nonoperative group were managed with closed reduction of the fracture and plaster cast application under an image intensifier. Those in the volar plating group were managed by open reduction and fixation with a volar locked plate. Preoperative and postoperative serial clinico-radiological follow-up was done. The range of movement, grip strength, functional outcome scores and radiological parameters were compared. Student's t-test was used for statistical analysis with significance at p < 0.05. Results: Range of movement and functional scores were significantly (p < 0.001) better in the volar plating group, but the difference in ulnar variance and radial and ulnar deviation was insignificant as compared to the nonoperative group. At 24 months follow-up, the nonoperative group had significantly more cases with malunion, articular incongruity and osteoarthritis. Conclusion: In cases of AO type B or C fractures of the distal radius, volar locked plating provides anatomical stable fixation and early mobilization with better clinico-radiological outcome as compared to conservative treatment. © 2014 The Japanese Orthopaedic Association.


Singh A.K.,Mayo Institute of Medical science | Vinay K.,Institute of Medical Science BHU
Journal of Orthopaedics and Traumatology | Year: 2013

Background: The aim of this retrospective study was to determine the need for bone grafting in the surgical treatment of displaced intra-articular calcaneal fractures. We reviewed 390 cases of displaced intra-articular calcaneal fractures treated with plate osteosynthesis with or without autologous iliac bone grafting, and compared outcomes and complications related to fracture stabilization. Materials and methods: Three hundred ninety patients with displaced intra-articular calcaneal fractures that were treated with plate osteosynthesis from December 2002 to December 2010 were reviewed. Two hundred two patients (group A) were treated by osteosynthesis with autologous bone grafting, and 188 patients (group B) were treated by osteosynthesis without bone grafting. One hundred eighty-one patients with an AO type 73-C1 fracture (Sanders type II), 182 patients with an AO type 73-C2 fracture (Sanders type III), and 27 patients with an AO type 73-C3 fracture (Sanders type IV) were included in this study. Bohler's angle, the crucial angle of Gissane, and calcaneal height in the immediate postoperative period and at the 2-year follow-up were compared. Any change in the subtalar joint status was documented and analyzed. The final outcomes of all patients were evaluated by the AOFAS Ankle-Hindfoot Scale and compared in both groups. Results: The mean full weight-bearing time in group A (with bone grafting) was significantly lower (median 6.2 months, range 2.8-9.2 months) than that in group B (without bone grafting; median 9.8 months, range 6.8-12.2 months). The immediate-postoperative Bohler's angle and that at the 2-year follow-up were significantly higher in group A. The loss of Bohler's angle after 2 years was significantly lower in group A (mean 3.5°; 95 % CI 0.8° -6.2°) than in group B (mean 6.2°; 95 % CI 1.0° -11.2°). The average change in the crucial angle and the average change in calcaneal height were not statistically significant for either group. The infection rate in the bone grafting group was higher, though statistically insignificantly so, than in the nongrafting group (8.3 vs. 6.3 %). No significant difference was found between the groups in terms of the rates of good reduction, postoperative osteoarthritis, and subtalar fusion. Regarding the efficacy outcomes, the mean AOFAS score was lower (mean 76.4 points; 95 % CI 65.8-82.9 points) in group A than in group B (mean, 81.6 points; 95 % CI, 72.3-88.8 points), but this difference was not significant (p > 0.05). Conclusions: Bohler's angle showed improved restoration and the patients returned to full weight-bearing earlier when bone grafting was used in the treatment of intra-articular calcaneal fracture. However, the functional outcomes and complication rates of both groups were similar. © 2012 The Author(s).


Singh A.K.,Mayo Institute of Medical science | Rastogi A.,Institute of Medical science | Singh V.,Institute of Technology
Indian Journal of Orthopaedics | Year: 2013

Background: Distal femur fractures are difficult to manage and the selection of implant for internal fixation remains controversial. The objective of this study is to establish the relative strength of fixation of a distal femoral locking plate (DFLP) compared with the dynamic condylar screw (DCS) in the distal femur fractures. Materials and Methods: Study was conducted on 16 freshly harvested cadaveric distal femoral specimens, eight implanted with DCS and other eight with DFLP. The construct was made unstable by removing a standard sized medial wedge of 1 cm base (gap-osteotomy) beginning 6 cm proximal to the lateral joint line in distal metaphyseal region with the loss of medial buttress. Fatigue test was conducted under load control mode at the frequency of I Hz. Specimens were subjected to cyclic loading of 2 kN, under observation for 50,000 cycles or until failure/cutout, which ever occurred earlier. Results: In DFLP group, there was no implant failure and the average number of cycles sustained was 50,000. Six out of eight specimens completed 50,000 cycles and two failed in DCS group. The average number of cycles sustained by DCS was 46150. Though the bone quality as assessed by dual energy X-ray absorptiometry DEXA was comparable in both DFLP and DCS group ( P = 0.06), none failed in DFLP group and subsidence was 1.02 ± 0.34 mm (range: 0.60-1.32 mm), which was significantly 43% lower ( P = 0.006) than subsidence in DCS group (1.82 ± 0.58; range: 1.20-3.08 mm). The average stiffness of DCS group was 52.8 ± 4.2 N/mm, which was significantly lower than average stiffness of locked condylar plate group (71.2 ± 5.1 N/mm) ( P = 0.02). Conclusions: DFLP fixation of the distal femur fractures resulted in stronger construct than the DCS fixation in both cyclic loading and ultimate strength in biomechanical testing of a simulated A3 distal femur fracture.


Seth V.,Mayo Institute of Medical science | Yadav S.,Mayo Institute of Medical science
International Journal of Pharma and Bio Sciences | Year: 2015

Bronchial asthma is characterised by inflammation in airways leading to hyperreactivity and spasm of the bronchial smooth muscle, oedema and disruption of the mucosa, and obstruction of the lumen by mucus. The drugs used for asthma are broadly classified into bronchodilators (reliever therapies) and anti-inflammatory drugs (preventer therapies). The preventer therapies mainly include corticosteroids besides mast cell stabilizers, antileukotriene drugs and omalizumab. Omalizumab is a humanised monoclonal antibody which binds to circulating IgE. This compound has demonstrated efficacy in the patient population in a number of clinical studies and its use for severe allergic asthma has been endorsed by several international consensus bodies. It is generally indicated for patients unresponsive to high-dose inhaled steroids and have allergy as an important cause of their asthma. Omalizumab is given as a subcutaneous injection every two to four weeks depending on dose which in turn depends on the body weight and the IgE level. This review will further discuss the status of Omalizumab in the management of asthma and where does it fit into the treatment of asthma of different severities.


Singh A.K.,Mayo Institute of Medical science | Arun G.R.,Sri Mokambika Institute of Medical science | Narsaria N.,Mayo Institute of Medical science | Srivastava A.,Mayo Institute of Medical science
Archives of Orthopaedic and Trauma Surgery | Year: 2014

Background: The aim of this prospective comparative study was to compare outcomes and complications of humeral diaphyseal fracture non-unions managed with humerus interlocking nail (HIL) and locking compression plate (LCP). Materials and methods: 40 patients with non-union of humeral diaphyseal fractures were included in this study and were randomly allocated in two groups; group A had 20 cases treated with HIL and group B had 20 cases treated with LCP. Clinico-radiological assessments were done for each case up to 2-year follow-up period. Primary outcome measures (time to fracture union, union rate) and secondary outcome measures (functional outcome and complication such as infection, malunion, delayed union, implant failure, joint stiffness and iatrogenic radial nerve palsy) were compared between both the groups. Disabilities of the arm, shoulder and hand (DASH) scoring and Steward and Hundley's scoring system were used to assess functional outcome of the fracture fixation. Results: There was no significant difference (p = 0.12) in terms of mean fracture union time between group A (15.8 ± 4.2 weeks) and group B (17.2 ± 3.8 weeks). Group A had 95 % union rate and group B had 100 % union rate (p = 0.14). At the 2-year follow-up visit, there was no significant difference found between both the groups regarding range of motion of shoulder and elbow joint. There was no significant difference found in final functional outcomes between both the groups on comparing DASH score (p = 0.14) and Steward and Hundley's score (p = 0.08). In terms of complications, there was insignificant difference found between both the groups. Conclusions: This study concludes that both the implants can be used in non-union of humeral shaft fractures with good functional outcomes and acceptable rate of complications. © 2014 Springer-Verlag.

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