Background: Knee proprioception is compromised in knee osteoarthritis. There are several ways of measuring proprioceptive acuity, but there is lack of consensus over the ideal testing position. The study aimed to evaluate the influence of 2 testing positions (sitting versus prone lying) on proprioceptive knee assessment score in patients with early knee osteoarthritis. Methods: The study included 70 subjects who came to the Out-Patient Department with a diagnosis of early knee osteoarthritis. The subjects were assessed for their proprioceptive acuity scores in both the test positions at 30° and 60° of knee flexion using proprioceptive knee assessment device. They were asked to perform 5 trials in both testing positions with appropriate rest intervals. After initial assessment, the subjects were randomly allocated among group 1 and group 2. Treatment implementation was done for 8 weeks followed by re-evaluation: group 1 received context-specific proprioceptive retraining along with multijoint coupling strategies and group 2, conventional treatment. Results: The subjects were compared using difference of pre- and post-treatment proprioceptive acuity scores. The difference of proprioceptive acuity impairment scores of the left knee at 30° and 60°, and the right knee at 60° in prone lying position were statistically significant, with P value ranging from less than 0.001 to 0.028. Conclusion: It was found that the prone lying testing position was more sensitive than sitting position for assessing proprioceptive acuity for knee osteoarthritis.

PURPOSESoft tissue healing is of paramount importance in distal tibial fractures for a successful outcome. There is an increasing trend of using anterolateral plate due to an adequate soft tissue cover on ante- rolateral distal tibia. The aim of this study was to evaluate the results and complications of minimally invasive anterolateral locking plate in distal tibial fractures.

METHODSThis is a retrospective study of 42 patients with distal tibial fractures treated with minimally invasive anterolateral tibial plating. This study evaluates the bone and soft tissue healing along with emphasis on complications related to bone and soft tissue healing.

RESULTSFull weight bearing was allowed in mean time period of 4.95 months (3-12 months). A major local complication of a wound which required revision surgery was seen in one case. Minor complications were identified in 9 cases which comprised 4 cases of marginal necrosis of the surgical wound, 1 case of superficial infection, 1 case of sensory disturbance over the anterolateral foot, 1 case of muscle hernia and 2 cases of delayed union. Mean distance between the posterolateral and anterolateral incision was 5.7 cm (4.5-8 cm).

CONCLUSIONThe minimally invasive distal tibial fixation with anterolateral plating is a safe method of stabilization. Distance between anterolateral and posterolateral incision can be placed less than 7 cm apart depending on fracture pattern with proper surgical timing and technique.

Adult ; Aged ; Bone Plates ; Female ; Fracture Fixation, Internal ; adverse effects ; methods ; Humans ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; adverse effects ; methods ; Tibial Fractures ; surgery

Osteoid osteomas are benign skeletal neoplasms that are commonly encountered in the bones of the lower extremities, but are exceedingly rare in jaw bones with a prevalence of less than 1%. This unique clinical entity is usually seen in younger individuals, with nocturnal pain and swelling as its characteristic clinical manifestations. The size of the lesion is rarely found to be more than 2 cm. We hereby report a rare case of osteoid osteoma originating from the neck of the mandibular condyle that grew to large enough proportions to result in conductive hearing loss in addition to pain, swelling and restricted mouth opening. In addition, an effort has been made to review all the documented cases of osteoid osteomas of the jaws that have been published in the literature thus far.
Hearing Loss ; Hearing Loss, Conductive* ; Jaw ; Lower Extremity ; Mandibular Condyle* ; Mouth ; Neck ; Osteoma ; Osteoma, Osteoid* ; Prevalence

PURPOSETo report complications in the management of complex closed proximal tibial fractures.

METHODA retrospective study was conducted to analyze the infectious and noninfectious complications encountered in the management of high-energy Schatzker type V and VI tibial plateau fractures. All patients were treated at the level 1 trauma centre between January 2011 and March 2014. Sixty two patients were included in the study. The mean patient age was (43.16 ± 11.59) years with 60 males and 2 females. Infectious complications like superficial and deep infection, wound dehiscence, malalignment in the immediate postoperative period and in follow-up period were noted.

RESULTSThe overall complication rate was 30.65% (19 out of 62). Infectious complications were noted in 20.97% cases (13/62). In majority of the cases (8/13), superficial infection was seen which managed with regular dressing and antibiotic administration. The patients (5/13) who had developed deep-seated infection were subjected to repeated debridements, flap coverage, implant removal or amputation depending upon the host response. Thirteen patients had experienced noninfectious complications. Hardware related complications were noticed in six patients and four among them received a secondary procedure. Malalignment was observed in seven patients but only single patient underwent subsequent operative intervention.

CONCLUSIONProximal tibial plateau fractures especially Shatzker type V and VI are associated with extensive soft tissue damage even in closed injuries. The complications encountered in the management of these fractures can be minimized with appropriate patient selection and minimal soft tissue dissection.

Adult ; Fasciotomy ; Female ; Fracture Fixation ; adverse effects ; Fractures, Closed ; surgery ; Humans ; Male ; Middle Aged ; Postoperative Complications ; therapy ; Retrospective Studies ; Tibial Fractures ; surgery

Objective: To compare the efficacy of a Neurofacilitation of Developmental Reaction (NFDR) approach with that of a Conventional approach in the modulation of tone in children with neurodevelopmental delay. Methods: Experimental control design. A total of 30 spastic children ranging in age from 4 to 7 years with neurodevelopmental delay were included. Baseline evaluations of muscle tone and gross motor functional performance abilities were performed. The children were allocated into two intervention groups of 15 subjects each. In groups A and B, the NFDR and conventional approaches were applied, respectively, for 3 months and were followed by subsequent re-evaluations. Results: Between group analyses were performed using independent t test for tone and primitive reflex intensity and a Mann-Whitney U test for gross motor functional ability. For the within-group analyses, paired t tests were used for tone and primitive reflex intensity, and a Wilcoxon signed-rank test was used for gross motor functional ability. Conclusion: The NFDR approach/technique prepares the muscle to undergo tonal modulation and thereby enhances motor development and improves the motor functional performance abilities of the children with neurodevelopmental delay.

Brain ; pathology ; Humans ; Hyponatremia ; complications ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Myelinolysis, Central Pontine ; diagnosis ; etiology ; pathology ; physiopathology ; therapy ; Osmolar Concentration ; Osmosis ; Osmotic Pressure ; Risk Factors ; Time Factors

A simple, rapid and sensitive ultra performance liquid chromatography-tandem mass cilostazol and its pharmacologically active metabolite 3,4-dehydro cilostazol in human plasma using deuterated analogs as internal standards (ISs). Plasma samples were prepared using solid phase extraction 18 (50 mm ? 2.1 mm, 1.7 mm) column. The method was established over a concentration range of 0.5–1000 ng/mL for cilostazol and 0.5–mL for 3,4-dehydro cilostazol. Intra-and inter-batch precision (%CV) and accuracy for the analytes were found within 0.93–1.88 and 98.8–101.7% for cilostazol and 0.91–2.79 and 98.0–102.7% for the metabolite respectively. The assay recovery was within 95–97% for both the analytes and internal standards. The method was successfully applied to support a bioequivalence study of 100 mg cilostazol in 30 healthy subjects.

OBJECTIVETo evaluate functional outcome and complications of open reduction and internal fixation with proximal humeral internal locking system (PHILOS) plate for proximal humerus fractures.

METHODSWe reviewed 51 patients who underwent open reduction and internal fixation with PHILOS plate between the years 2007 to 2012. There were 35 men and 16 women with a mean age of 38 years (range 24-68). There were 41 patients in the age group of <60 years and 10 patients in the age group of >60 years. According to Neer classification system, 8, 15 and 23 patients had 2-part, 3-part, and 4-part fractures, respectively and 5 patients had 4-part fracture dislocation. All surgeries were carried out at our tertiary care trauma centre. Functional evaluation of the shoulder at final follow-up was done using Constant-Murley score.

RESULTSThe mean follow-up period was 30 months (range 12-44 months). Two patients were lost to follow-up. Of the remaining 49 patients, all fractures were united clinically and radiologically. The mean time for radiological union was 12 weeks (range 8-20 weeks). At the final follow-up the mean Constant-Murley score was 79 (range 50-100). The results were excellent in 25 patients, good in 13 patients, fair in 6 patients and poor in 5 patients. During the follow-up, four cases of varus malunion, one case of subacromial impingement, one case of deep infection, one case of intraarticular screw penetration and one case of failure of fixation were noted. No cases of avascular necrosis, hardware failure, locking screw loosening or nonunion were noted.

CONCLUSIONPHILOS provides stable fixation in proximal humerus fractures. To prevent potential complications like avascular necrosis, meticulous surgical dissection to preserve vascularity of humeral head is necessary.

Adult ; Aged ; Bone Plates ; Female ; Fracture Fixation, Internal ; instrumentation ; methods ; Fracture Healing ; Humans ; Male ; Middle Aged ; Postoperative Complications ; Recovery of Function ; Shoulder Fractures ; surgery ; Treatment Outcome

PURPOSETo evaluate the functional and radiological outcome of comminuted radial head fractures, which were not amenable for classical open reduction with internal fixation, treated by on-table reconstruction and fixation using low profile plates.

METHODSWe reviewed 6 patients of Mason type III radial head fractures treated by on-table reconstruction technique between 2011 and 2013. There were 5 men and 1 woman with a mean age of 35 years (range 25-46 years). All surgeries were carried out at our tertiary care level 1 trauma centre within a mean of 3 days (range 1-8 days) from date of injury using on-table reconstruction technique. The functional outcome was measured using elbow functional rating index described by Broberg and Morrey and the patient-based Disabilities of the Arm, Shoulder and Hand (DASH) outcome measure.

RESULTSThe mean follow-up period was 25 months. The average elbow flexion was 135°(range 125°-140°) and theaverage flexion contracture was 5°(range 0-10°). The average supination and pronation was 75°(range 70°-80°) and 70°(range 65°-82°) respectively. According to Broberg and Morrey scoring system, the average score was 90 points (range 75-100). The mean DASH score was 2.49 points.

CONCLUSIONOn-table reconstruction and fixation of comminuted radial head fractures using low profile plates is a reasonable option. The reconstructed radial head acts as spacer and provides reasonably good results and no surgical intervention is required for asymptomatic nonunion of these fractures regardless of the radiological findings.

Adult ; Bone Plates ; Female ; Fracture Fixation, Internal ; methods ; Fractures, Comminuted ; surgery ; Humans ; Male ; Middle Aged ; Radius Fractures ; surgery ; Reconstructive Surgical Procedures ; methods

Brain ; blood supply ; diagnostic imaging ; Brain Ischemia ; blood ; diagnosis ; diagnostic imaging ; Combined Modality Therapy ; methods ; Humans ; Male ; Middle Aged ; Monitoring, Physiologic ; Stroke ; drug therapy ; physiopathology ; Tomography, X-Ray Computed