INTRODUCTION:In all practical purposes various thoraco lumbar and lumbar surgeries like discectomy, laminectomy and spinal fusion procedures are usually performed under general anesthesia (GA). Our aim of this study is to assess whether spinal anesthesia is a better and effective alternative to general anesthesia in terms of economic advantage and functional recovery with both intra and post-operative heamodynamic stability. METHODS: In our study hundred patients with age group 25-45 yrs within the ASA criteria of class I-III were enrolled. All patients were randomly selected based on age, sex, ASS criteria, duration of surgery, heart rate (HR), mean arterial pressure (MAP), blood loss, previous history of risk factors and co morbidities. The severity of postoperative pain based on visual analogue scale (VAS) and use of analgesics post operatively, were recorded. RESULTS: There were 41 males and 59 females. The mean age of the patient was 39.28±9.27 yrs. Six patients had hypertension, 11 with diabetes. Patients with ASA Grade I and II and III were 60, 34 and 6 respectively. There were no episodes of air way compromises, 2 patients had spinal aneasthesia failures, no incidence of post dural puncture headache, 3 patients had mean blood pressure fluctuations among them, one patient had post-operative paraperesis due to hematoma treated by immediate decompression, and 13 patients had usage of propofol sedation in terms of comfort. The duration of surgery (range) was 77.25±22.44 min (40-120) Severity of postoperative pain after four hours of surgery on VAS was 3.24±0.46. Twenty two patients (22%) required analgesics. Two patients had post-operative vomiting. CONCLUSIONS: In our study we have considered that spinal anesthesia for advantages such as less blood loss, intra operative blood pressure and heart rate changes, postoperative pain, quick functional recovery and lower incidence of pulmonary complications. Additionally, during spinal anesthesia patient extremities and chest can be reposition as needed, to avoid nerve injury, brachial plexus palsy or pressure necrosis to either the face or chest wall and finally the most important being an economical advantage and patient and surgeons satisfaction. We showed that spinal aneasthesia is better and effective alternative to GA in providing postoperative analgesia and decreasing blood loss with both intra and post-operative hemodynamic stability without increasing adverse side effects.

We studied the clinical and functional outcome of distal radius fractures managed by ligamentotaxis and/or percutaneous pinning versus open reduction & internal fixation by buttress plates. METHODS: This prospective study was conducted during Aug 2012 to October 2014. All skeletally matured patients were having both Intra articular and extra articular Closed Distal Radius fractures were studied. Treatment was done either external fixator supplemented with k wires or internal fixation with plate and screws. The radiographic evaluation included radial length, palmar tilt, any evidence of jointincongruity and radio ulnar joint instability and arthritis. The assessments that were made includes Subjective assessmentpain, numbness, weakness of hand, stiffness, OBJECTIVE: Range of motion measured by hand held goniometer, Measurement of grip strength done by commercially available hand dynamometer. Unaffected hand served as control. RESULTS: Male patients (85.46%) outnumbered female patients (14.54%) in incidence. The incidence of distal radius fractures was common between the ages of 20 to 40 years. Left sided fractures were more common (52.73%). Type III was most common type of fracture (Frykman's Classification), accounting for 29% of all fractures.25 cases were treated by external fixation and 30 cases were treated by open reduction and buttress plating. The results were evaluated by using STEWART ET AL anatomical and functional scoring system. The average range of movement at the knee joint was Dorsiflexion 70*, Palmar Flexion 65*, Ulnar Deviation 25*, Radial Deviation 15*, Supination 70*, Pronation 65*. Most common early complication was pin tract infection. Based on the stewar et al scoring, 4(7.27%) had excellent, 43(78.18%) had good, 7(12.72%) had fair, 1(1.81%) had poor results. CONCLUSION: We observed that both fixations were equally same, there is no superiority with over the other. The incidence of complications in internal fixation (10%) is fewer compared to external fixation (24%) in this study.