A prospective randomized pilot study of steroid modulation of cytokine (Interleukin 6) release in unilateral total knee replacement surgeries

Abstract

Background: Distal fractures of the femur especially comminuted, intra-articular distal femoral fractures AO classification 33-C remain challenging fractures for orthopaedic surgeons. Due to soft tissue damage, comminution, articular involvement and extensor mechanism injury functional outcome is poor in fracture distal femur. Materials and Methods:We have done prospective study of 20 patients of intraarticular distal femur fracture AO classification 33-C treated operatively with locking compressive plate at S.S.G. hospital and medical college, Baroda during January 2014 to March 2016.We have studied functional outcome using neer's score, radiological outcome and complication associated with fracture fixation using LCP. Result: Out of 20 patients 14 were males and 6 were females. The youngest patient was 18yrs old and the oldest 70 yrs.4 patients had C1,10 pt had C2 and 6 pt had C3 type of fracture according to AO classification,12 patients were operated with extensile lateral approach.8 patients were operated using Swashbuckler approach. In 3 patients primary bone grafting was done for severely comminuted type C3 fracture. Secondary bone grafting was done in 1 delayed union case at 4 month. Pt shows sign of union at 9 month.1 Pt develop non-union treated with secondary bone grafting at 9 month with signs of union at 12 month.1 pt develop infection on 4 th post-operative day resolved with surgical debridement and antibiotic. The average duration of weight bearing was12 weeks. Average time for fracture healing was 20 weeks. Average range of motion of knee was 110 degrees. Among 20 patients there were 9 excellent result, 5 good results, 3 had fair results and 3 had poor results. Discussion: The LCP acts on the internal fixator principle as screws once locked to the plate do not pull the fracture towards the implant, and hence there is no displacement of the fracture once reduced. Distal femur locking plate provides angular stability and provides multiple options to secure fracture fragments, both metaphyseal and articular. In our study we get better functional outcome using locking compression plate for intraarticular distal femoral fracture. Along with anatomical reduction and rigid fixation, early mobilization and aggressive physiotherapy are key for better functional outcome. Conclusion: In present study better functional outcome achieved using locking compression plate for intraarticular distal femoral fracture along with aggressive physiotherapy.

Systemic glucocorticoids as an adjunct to treatment of postoperative pain after total hip and knee arthroplasty

“…Pain at rest (24 h) was reduced by 6.3 mm (95% CI 3.8 to 8.8, P < 0.00001, I 2 = 90%, 18 trials, 50,55,56,58,60–62,65–67,69–72,74,77,80,81 2100 patients, 4 low risk of bias, GRADE: Low) compared with controls (Figure, SDC 5.2, http://links.lww.com/EJA/A780).…”

“…Our search identified 14 107 unique citations, and ended with a final inclusion of 32 RCTs 50–81 and a total of 3521 patients (Fig. 1).…”

“…Eight trials, 52,56,63,64,70 (one low risk of bias, 52 two trials included patients with diabetes, 56,78 four trials used dexamethasone equivalent doses ≥16 mg, 52,70,78,81 1220 patients) reported blood glucose levels (Figure, SDC 5.7, http://links.lww.com/EJA/A780). No significant difference in blood glucose was found between groups on POD 1 or 2 (POD 1: 0.2 mmol l −1 , 95% CI 0.0 to 0.5, I 2 = 56%, P = 0.08; POD 2: -0.1 mmol l −1 , 95% CI -0.3 to 0.2, I 2 = 45%, P = 0.66).…”