In spite of advances in techniques and improvements in surgical implants, confusion still prevails regarding use of specific implants in distal femur fracture. Fractures in the distal femur have posed considerable therapeutic challenges throughout the history of fracture treatment. Most of these surgical failures were due to inadequate fixation of the fracture fragments. The Aim of the study is to determine whether distal femur locking plates are superior implants than dynamic condylar screw and distal femur nail. A prospective and observational study was done in Department of Orthopaedics and Traumatology, Sri Ramachandra Medical Collage, Chennai between Jan. 2011 and Jan. 2015. Patients with distal femoral fractures, admitted into the hospital, were treated using various modes of internal fixation and followed up over a period of six months to one year and their functional outcome was evaluated. The functional and radiological assessment of patients during follow-up was done using Neer's criteria. The use of any one of the implant, i.e. distal femur locking plates, dynamic condylar screw or distal femur nailing for internal fixation, depends on the type of fracture and the pre operative planning and intra operate decision of the surgeon. In our study, 38% of fractures treated by Dynamic condylar screw, 72% of fractures treated by distal femur locking plate and 42% of fractures treated by Distal femur supracondylar nail had excellent/satisfactory results. Locking plates had better outcome in both extra-articular and intra-articular group. They also had better outcome in both younger and older age groups.

Background: Capillary hemangiomas are benign vascular lesions commonly seen in subcutaneous tissues. The most common site of origin is from the vertebral body, and only a few cases of isolated lesions in thoracic epidural space, especially after trauma, have been reported in the literature. Case Description: We report a case of 63-year-old male with progressive bilateral lower limb weakness and exaggerated lower limb deep tendon reflexes without bowel and bladder involvement. His history revealed T7 fracture with paraparesis which was treated surgically, and implants were removed a year later. MRI showed an epidural lesion from T6-T8 extending into the right T7-8 foramen which showed hypointensity on T1, hyperintensity on T2, and homogenous enhancement in contrast images with severe cord compression. Laminectomy was done and the lesion was removed en bloc. Histopathological examination revealed it to be capillary hemangioma. The neurology came back to normal after 3 months. Conclusion: Although capillary hemangiomas are rare lesions, it has to be considered in the differential diagnosis of epidural space-occupying lesions which require early surgical removal to prevent a progressive and permanent neurological deficit.

Study DesignRetrospective cohort study.PurposeTo compare the clinical and radiological outcomes of modified mini-open transforaminal lumbar interbody fusion (modMOTLIF) and open TLIF (OTLIF).Overview of LiteratureMinimally invasive transforaminal lumbar interbody fusion (MTLIF) is associated with less blood loss, shorter hospital stay, and less pain. However, it has concerns like increased radiation exposure, steep learning curve, and instrumentation cost. We modified the MTLIF technique by direct freehand insertion of pedicle screws using stab incisions without tubular retractors.MethodsThe study included 24 patients in the modMOTLIF group and 27 patients in the OTLIF group. The average follow-up period was 25.6 months. Clinical outcomes were measured using Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores. Serial X-rays were acquired at 1, 3, 6, 12, and 24 months to assess the union and presence of instability. We also compared blood loss and length of hospital stay in both groups.ResultsAll patients showed progressive improvement in VAS and ODI scores. No differences were observed in the preoperative and postoperative ODI and VAS leg scores between the groups. The immediate postoperative VAS back score was significantly higher in the OTLIF group than in the modMOTLIF group; however, no difference was observed at 1 and 2 years. Radiological analysis showed nonunion in one and two patients in the OTLIF and modMOTLIF groups, respectively. The average blood loss was 63 mL in the mod-MOTLIF group and 254 mL in the OTLIF group. The mean hospital stay was 3 days for the modMOTLIF group and 5 days for the OTLIF group.ConclusionsmodMOTLIF was associated with reduced blood loss and shorter hospital stay compared with OTLIF. No significant differences were observed in the clinical and radiological outcomes between the groups after 2 years despite reduced back pain in the immediate postoperative period in patients who underwent modMOTLIF.

Background: Diabetes mellitus is one of the leading causes of morbidity resulting in multi-organ dysfunction. Animal studies have shown that hyperglycemia results in stress-induced senescence through the p16-pRb pathway, thereby accelerating early disc degeneration. There is a paucity of literature on the effect of hyperglycemia in human intervertebral disc cells. We aimed to analyze the effect of diabetes mellitus in human intervertebral disc cells. Methods: This is a prospective study done in patients with degenerative disc disease. Patients were categorized into a control group (no diabetes: 26 patients) and a study group (type 2 diabetes for. 3 years: 24 patients). All patients underwent either discectomy or transforaminal lumbar interbody fusion and the removed disc was transported to pathology department. Tissue was prepared and histopathological grading was done followed by immunohistochemistry studies using antibodies for MMP-1, p21, p16, and pRb. Results: Samples from diabetic patients had severe (grade 2) degenerative changes compared with the control group (grade 1). Changes were more intense in the nucleus pulposus with increased cellularity and clustering of chondrocytes, and disorganization and loss of nuclear matrix. Immunohistochemical staining for MMP1, p16, and pRb was more intense (Q score ¼ 4) whereas the staining for p21 was less intense (Q score ¼ 1) in the diabetic group compared with the control group. Conclusion: Our study demonstrates that type 2 diabetes mellitus accelerates stress-induced senescence in human intervertebral discs resulting in early disc degeneration. Also, the severity of disc degeneration is severe compared with the normal subjects. Clinical Relevance: Hyperglycemia can affect the intervertebral discs similar to other organs and hence adequate control of blood glucose in diabetics can prevent the disc degeneration, which is the initiator of degeneration cascade in spine.

Introduction: Low back pain is one of the most common cause for outpatient visits. Though few studies have shown the vital role of paraspinal muscles in lumbar spine pathology, literature is scarce regarding the influence of the paraspinal muscles in disc degeneration. We aimed to analyse the correlation between paraspinal muscles and disc degeneration. Methods: This is a Level III Prospective Cohort Study done in MRI of lumbosacral spine in 504 patients at 2520 levels from L1-2 to L5-S1. The parameters assessed were age, Pfirrmann grade for disc degeneration and paraspinal muscle (Multifidus and Erector Spinae) mass assessed by the gross cross sectional area of the muscle.The values and their correlation was analyzed using SPSS software. Results: The study included a total of 504 patients (231 males and 273 females) with a mean age of 52.00 ± 15.00 (22e80) years. The mean GCSA in cm 2 of the paraspinal muscles at L1-L2, L2-L3,L3-L4,L4-L5,L5-S1 were 16.177 ± 2.72, 17.275 ± 2.16, 16.900 ± 3.07, 16.800 ± 2.63, 13.426 ± 2.42 respectively. We found that the age of the patient is directly proportional to the disc degeneration and inversely proportional to GCSA of paraspinal muscle. There was a significant negative correlation between disc degeneration and paraspinal muscle mass. Conclusion:We found that the paraspinal muscle mass reduces and Pfirrman's Grade increases as age advances. Also patients with disc degeneration tend to have wasting of paraspinal muscles and vice versa. Hence, strengthening the paraspinal muscles should be emphasised to prevent back pain and to stall the degeneration cascade.