BACKGROUND Hip joint is a polyaxial ball and socket joint. At different stages of gait cycle, joint reaction forces at the hip joint depend on abductor leaver arm which is function of neck length (Offset), neck shaft angle and body weight. During Arthroplasty operation of hip, femoral offset measurement and its restoration to anatomical limit is important. In our study, we have measured the femoral neck length, between two fixed bony points, from the tip of greater trochanter (GT) to the center of the femoral head peroperatively and again post-operatively, from the true size x-ray of the replaced femoral head. We compared this measurement with the postoperative x-ray of normal side hip, to compare, how far normal offset is achieved after operating with various prosthesis (fixed bipolar prosthesis and modular prosthesis) available in the Indian scenario. MATERIALS AND METHODS This is a prospective, comparative study on presentation at in-patient department (IPD). Total 53 patient (22 male and 31 female) above 60 years of age, admitted at our institution 'Ramakrishna Mission Seva Prathistan (VIMS)' in the year 2015-16, with intracapsular fracture neck femur of either right or left side were studied. Per-operative measurement was taken during hemiarthroplasty operation using fixed bipolar prosthesis or modular prosthesis (cemented/un-cemented) available in the Indian market. Post-operative measurement taken in the true size x-ray of two fixed points on the operated and normal side. Limb length was measured clinically. The values obtained were compared to establish how far the normal anatomical offset is achieved after hemiarthroplasty operation by using prosthesis manufactured by different companies in India. RESULTS Intraoperative measurement of distance between tip of GT and center of femoral head corresponded with the measurement taken from tip of GT to the prosthetic femoral head. This signifies that we have successfully corrected the offset with available prosthesis with correct surgical technique. There is no significant difference in the postoperative true size x-ray of distance between tip of GT to the center of prosthetic femoral head and the tip of GT with center of femoral head of normal side. CONCLUSION Our study results shows that by opting correct surgical technique and appropriate neck resection, currently available prosthesis (FBP & MBP) in our country can achieve desired neck offset length in comparison to the normal hip and had no significant limb length discrepancy.
Background: de Quervain's disease (DQ) is painful tenosynovitis of first dorsal compartment of hand. It is usually caused by overuse or repetitive activity. There are various modalities of treatment of DQ. Different studies have shown effectiveness of local corticosteroid injection, splinting or both in western population but to our knowledge, there is no effectiveness data available for Indian population. This study was performed to compare the outcome of corticosteroid injection versus splinting for the treatment of de Quervain's tenosynovitis. Methods: This randomized prospective study was conducted from July 2015 to December 2016 in Orthopaedics OPD of RKMSP.A total of 100 patients with de-Quervain's tenosynovitis were treated with either of these methods1) corticosteroid injection in first dorsal compartment of wrist, 2) splinting, local ice or hot compression and topical Non-Steroidal Anti-Inflammatory (NSAIDs) gel. Treatment effectiveness was measured by Wong-Baker FACES Pain Rating Scale, 0-10 Numeric Pain Rating Scale, size of nodule over radial styloid and grading of tenderness over 1st dorsal compartment. Results: In the first group, a total of 50 patients were included (corticosteroid injection), and 50 patients in the second group (splinting, local ice or hot compression and topical Non-Steroidal Anti-Inflammatory (NSAIDs) gel). The mean age was 32.6 years (21 -61 years) in all patients. There were 90 women and 10 men. Overall success rate was 90% in the first and 60% in the second groups, with a significant difference for both groups with respect to pain score and cure rate (P<0.05). Temporary pain was the most common adverse reaction at the site of injection and was noted in 40% of patients. Conclusion:Though steroid injection has excellent outcome, splinting can be an alternative viable treatment option for dQ especially in patients with low grade disease or reluctant to injection because of fear of probable adverse reactions.
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