We studied 95 patients who underwent knee Arthroscopy under local anaesthesia between JANUARY 1995 till 1997. Materials used were 1% Xylocaine and 0.25% Bupivacaine of 20 mls each combined with midazolam 2 mg and IV pethidine 30 mgm for sedation. The patients were attached to monitors (pulse Oxymeter, ECG and BP and pulse recorders) and blood less field was created using a tornquet. The procedures lasted about 45 minutes. 90 out of 95 patients completed the procedures successfully without any complications. 2 developed respiratory embarrassments and were intubated and ventilated. 3 procedures abandoned and converted to general anaesthesia. The range of procedures done include meniscectomy, meniscal repair, synovial biopsy, debridement for osteoarthrosis, shaving of osteophytes, drilling of cartilage and bones and removal of loose bodies. This study is to show that knee arthroscopy under LA is a safe alternative in hospitals where GA time is limited.
A 42 years old gentleman presented with predominant low back pain associated with bilateral lower limb neurological deficit leading to an initial diagnosis of lumbar stenosis. Further history taking and examination revealed upper limb neurological deficit, and the lower limbs actually presented with upper motor neuron instead of lower motor neuron signs. Imaging studies confirmed the clinical findings with presence of both cervical and lumbar spinal stenosis. Twostage decompression procedures were performed at 6 monthintervals starting with cervical decompression. Postoperative improvement was noted on follow-up. This case highlights the importance of accurate diagnosis of cervical pathology for patients presenting with or referred for predominantly lumbar symptomology
Objective: to assess the severity of neck pain and functional status (neck motion and return to pre-injury daily activity) in patients with type 2 odontoid fracture following conservative treatment by halo vest immobilization. Methodology: A retrospective cohort study of 21 patients with type 2 odontoid fracture treated conservatively with halo ves immobilization from January 2007 and followed-up til December 2009. Fracture union and complications related to treatment were documented. At the final follow up visit (1 year post injury), the patient’s neck pain, neck range o motion and return to pre-injury daily activities were assessed. Result: Twenty-one patients were included in the study. Fracture union was documented in 17 patients (81%) only 4 suffered from nonunion. Despite the good union rate only 8 patients (38.1%) achieved a good neck range o motion and returned to pre injury daily activity. Neck pain was minimal in all patients. Conclusion: Type 2 odontoid fractures treated with halo vest results in good union and minimal residual neck pain; however, it causes neck stiffness.
Objective: To compare the fusion rate between autogenous tricortical iliac crest bone graft and hydroxyapatite block graft in anterior cervical discectomy and fusion (ACDF) surgery. Methodology: Retrospective review of cases that underwent ACDF surgery between 2005 and 2008. They were divided into two groups based on the graft material used. Assessment of fusion at 6 months post-surgery was carried out based on the static lateral cervical radiograph. Results: 32 cases were reviewed; 16 in each arm. There were 29 discectomies performed in the hydroxyapatite group as compared to 22 in the iliac crest group. 18 levels in the hydrxyapatite group showed radiological fusion while in the iliac crest group there were 21 levels fused. Seven patients had donor site pain. Conclusion: The fusion rate for autogenous tricortical iliac crest bone graft in anterior cervical discectomy and fusion surgery was 95%, a more superior fusion rate than that of hydroxyapatite block graft which was 62.1%.
Objectives: To study the prevalence and the risk factors for surgical site infection in patients who underwent posterior instrumented surgery for thoracolumbar burst fractures. Methodology: Retrospective review of cases operated between year 2006 and 2007. The final end point is the detection of surgical site infection within one year. Results: A total of 38 cases were reviewed. Surgical site infection occurred in 5 cases. Only one had deep infection. The onset of infection occurred within one month in all cases. The risk factors studied were smoking, timing of surgery, duration of surgery, neurological deficit, associated injuries and high dose methylprednisolone administration. None of them were statistically significant as risk factors for surgical site infection. Conclusion: The prevalence of surgical site infection in patients who underwent posterior instrumented surgery for thoracolumbar burst fractures was 13%.
OBJECTIVE: The aim is to find rate of return to work of surgically treated thoracolumbar fracture patients and to know if back pain, compensation issues or neurological status influence this rate.
METHODOLOGY: A retrospective cohort study analysing the patients with thoracolumbar fractures treated surgically from January 2008 till December 2009.
RESULTS: Neurological status is the main factor deciding return to work in this group. Back pain and compensation related issues were not statistically significant in influencing return to work. 74% of patients in this group return to work.
CONCLUSION: Return to work among the patients with thoracolumbar fracture, treated surgically, is mainly dependent on neurological status and not the compensation related issues or back pain.
Bone graft is essential in various orthopaedic procedures. Among the many donor sites for harvesting autologous bone graft, the iliac crest has been the most commonly used. However, for foot and ankle procedures the proximal tibia has gained popularity as an alternative donor site due to its anatomic proximity to the primary surgical site. In this article we evaluated the possible complications associated with harvesting proximal tibia bone graft. Our study showed the low incidence of morbidity in harvesting proximal tibia bone graft, thereby providing a good alternative donor for foot and ankle procedures.