Study DesignRetrospective analysis.PurposeWe evaluated the functional, neurological, and radiological outcome in patients with thoracic and thoracolumbar tuberculosis operated through the transpedicular approach.Overview of LiteratureFor surgical treatment of thoracic and thoracolumbar tuberculosis, the anterior approach has been the most popular because it allows direct access to the infected tissue, thereby providing good decompression. However, anterior fixation is not strong, and graft failure and loss of correction are frequent complications. The transpedicular approach allows circumferential decompression of neural elements along with three-column fixation attained via pedicle screws by the same approach.MethodsA total of 47 patients were diagnosed with tuberculosis of the thoracic or thoracolumbar region from August 2012 to August 2013. Of these, 28 patients had progressive neurological deterioration or increasing back pain despite conservative measures and underwent transpedicular decompression and pedicle screw fixation with posterior fusion. Antituberculosis therapy was given till signs of radiological healing were evident (9–16 months). Functional outcome (visual analog scale [VAS] score for back pain), neurological recovery (Frankel grading), and radiological improvement were evaluated preoperatively, immediate postoperatively, and at 3 months, 6 months, and 1 year.ResultsMean VAS score for back pain improved from 8.7 preoperatively to 1.1 at 1 year follow-up. Frankel grading preoperatively was grade B in 7, grade C in 11, and Grade D in 10 patients, which improved to grade D in 6 and grade E in 22 patients at the last follow-up. Radiological healing was evident in the form of reappearance of trabeculae formation, resolution of pus, fatty marrow replacement, and bony fusion in all patients. Mean correction of segmental kyphosis postoperatively was 10.5°. Mean loss of correction at final follow-up was 4.1°.ConclusionsTranspedicular decompression with instrumented fusion is a safe and effective approach for management of patients with thoracic and thoracolumbar tuberculosis.

Background:Complex AO type C3 fractures of the distal femur are challenging injuries, fraught with complications such as malunion and stiffness. We prospectively evaluated a consecutive series of patients with complex AO type C3 distal femur fractures to determine the clinicoradiological outcome after fixation with a single locked plate using modified swashbuckler approach.Materials and Methods:12 patients with C3 type distal femur fractures treated with a lateral locked plate, using a modified swashbuckler approach, were included in the study. The extraarticular component was managed either by compression plating or bridge plating (transarticular approach and retrograde plate osteosynthesis) depending on the fracture pattern. Primary bone grafting was not done in any case. The clinical outcome at 1 year was determined using the Knee Society Score (KSS). The presence of any secondary osteoarthritis in the knee joint was noted at final followup.Results:All fractures united at a mean of 14.3 ± 4.7 weeks (range 6–26 weeks). There were no significant complications such as nonunion, deep infection, and implant failure. One of the patients underwent secondary bone grafting at 3 months. The mean range of motion of the knee was 120° ± 14.8° (range 105°–150°). Seven patients had excellent, three patients had good and two patients had a fair outcome according to the KSS at 1 year. At a mean followup of 17.6 months, three patients showed radiological evidence of secondary osteoarthritis of the knee joint. However, only one of these patients was symptomatic.Conclusion:The results of complex C3 type distal femur fractures, fixed with a single lateral locked plate using a modified swashbuckler approach, are encouraging, with a majority of patients achieving good to excellent outcome at 1 year.

Background and Objectives: Depression has acknowledged and well documented, is common among orthopaedic inpatients may be associated with functional outcomes. Authors aimed to investigate the role, prevalence and associating factors of depression disorder in orthopaedic inpatients. Materials and Methods: A cross-sectional study is designed among patients that admitted at Sri Aurobindo Medical College and P. G. Institute, Indore. Four hundred twenty six orthopedic patients were recruited for study. The demographic and clinical measurements were recorded. Levels of depression were assessed by using Zung's depression scale. Results: Depressive disorder was identified in 87.6% indoor patients significantly (p<0.001) influenced female more than male. The mean depression score in female (67.37±11.75) was significantly higher than male (62.29±12.20). The prevalence of extreme/major depression in female (46.6%) was higher as compared to male (25.7%). Type of trauma was found significantly (p<0.05) associated with depressive disorder. 38.1% male with traumatic condition and 20.0% with non-traumatic condition had moderate depression in comparison to 31.4% and 13.6% female. Depressive disorder was found significantly associated with sex (p<0.001), socio-economic status (p<0.001), length of ortho-illness (p<0.001), length of stay in hospital (p<0.001), exercise/yoga (p<0.05) and type of injury (p<0.05). Conclusions: Higher incidence of depressive disorder recorded in female. Prevention and treatment require more clinical and research attention to reduce the public health burden of depression. The study suggested that higher depressive disorder does occur in indoor orthopaedic patients that associated with various functional outcomes. This study supports the view of depressive disorder was disabling factor in better functional recovery and frequent in female after orthopedic trauma.

BACKGROUND: Flexible intramedullary nails have gained widespread popularity for stabilization of pediatric fractures of long bones of lower extremity. AIMS: Purpose of our study was to evaluate safety and efficacy of titanium elastic nailing system (TENS) for paediatric lower extremity long bone fractures. METHODS: All children operated for lower extremity long bone fractures at our tertiary care centre (Sri Aurobindo Institute of Medical Sciences, Indore) between Jan 2012 to Dec 2013 who underwent fixation with TENS were reviewed. Out of 57 cases identified, 4 cases were lost to follow-up. Of the 53 cases, 58.49 per cent were males (boys 31 and girls 22). The average age of patients was 10.8 years (range 6-14 years). The mean weight was 28.8 kg (range 16 kg-42 kg). All fractures were reduced by closed manipulation. Outcomes were classified as excellent, satisfactory or poor according to Flynn flexible nail fixation classification. RESULTS: As per Flynn classification, we had 36 excellent, 14 good and 1 poor result. All patients attained complete healing at mean of 11.2 weeks (Range 7-16 weeks). Mean duration of hospital stay was of 5 days (Range 3-16 days). CONCLUSION: On the basis of results obtained TENS is an effective method for management of unstable paediatric fractures of long bones of lower extremity allowing rapid mobilization with minimal complications.

Study DesignSingle-surgeon, single-center prospective study with prospective data collection.PurposeTo clinically evaluate muscle damage after open lumbar surgery and its relationship to functional activity and to validatethe improvement in function as indicated by improved Oswestry Disability Index (ODI) score despite muscle damage.Overview of LiteratureFew studies have analyzed the functional loss and recovery pattern of muscles after open lumbar surgery.MethodsThe study included 30 patients who underwent open lumbar spine fusion surgery at our institution between August 2013 and May 2015. Preoperatively and at 6 months postoperatively, the patients were subjected to functional, biochemical, electrophysiological, and radiological assessments as outpatients, and the results were compared.ResultsMean preoperative and 6-month postoperative values were as follows: creatine phosphokinase levels, 133.07±17.57 and 139±17.7 U/L (p <0.001); Visual Analog Scale scores for backache, 6.73±0.88 and 3.27±0.96 (p <0.001); and ODI scores, 41.6±5.51 and 22.4±4.48 (p <0.001), respectively. Preoperatively, electrophysiological studies showed that 20% of the patients had a polyphasic configuration whereas at 6 months postoperatively, all patients had polyphasic configuration (p <0.001). The mean cross-sectional area of the multifidus observed using magnetic resonance imaging (MRI) decreased from 742.67±76.62 mm2 preoperatively to 598.27±66.38 mm2 6 months postoperatively (p <0.001), with all the patients exhibiting grade 2 atrophy.ConclusionsOpen lumbar fusion surgery resulted in significant damage to the lumbar paraspinal muscles, as indicated by a reduction in the cross-sectional area of the multifidus by MRI and denervation of the multifidus demonstrated using electromyography. Nevertheless, the patients reported reduced back pain and improved quality of life, which may have been due to increased stability of the previously unstable lumbar spinal segment after the surgery.