Efficacy of intra-articular tranexamic acid in blood loss reduction following primary unilateral total knee arthroplasty.

Purpose: The surgical stress of total knee arthroplasty (TKA) procedure and the application of intra-operative pneumatic thigh tourniquet increases local fibrinolytic activity, which contributes significantly to post-operative blood loss. Tranexamic acid, an antifibrinolytic drug, is commonly used to control post-operative blood loss. The recommended mode of administration of tranexamic acid is either oral or intravenous.

Treatment of Osteoporosis with Antiresoptive agent, Alendronate - warrants careful follow-up.

Introduction: Alendronate is the most popular bisphosphonate used to prevent fragility fracture of postmenopausal osteoporosis. There is common belief among physicians that Alendronates are very safe without many side effects and they continue it for long time. Recent papers have shown that, some patients who are on this drug from a long period suffered a rare type of fracture.

Alendronate induced femur fracture complicated with secondary hyperparathyroidism.

Alendronate is considered to be the gold standard drug for the treatment of postmenopausal osteoporosis. A 75 years old female presented with diaphyseal fracture following trivial fall. Though this fracture pattern was reported in the western world its presence among the population of this subcontinent is very rare.

Unusual presentation of altered bone metabolism with long-term antiepileptic therapy: pathological fracture of neck of femur due to brown tumor at calcer.

The antiepileptic drugs are known to alter the bone metabolism and result in various range of pathological conditions (osteoporosis, osteomalacia, vitamin D deficiency, secondary hyperparathyroidism). These clinical conditions developed either due to direct effect of these therapeutic agents on bone or due to alteration in the homeostasis of other regulators of bone metabolism like serum calcium, vitamin D, and parathyroid hormone. Long-term therapy with antiepileptic agents results in higher incidence of pathological fracture, which is a consequence of either osteoporotic or osteomalasic (secondary to vitamin D deficiency) changes in bone produced by these drugs.

Stratification and mobility in contemporary Egypt.

The objectives in this statement are to characterize and explain the patterns of change in stratification and mobility in Egypt, over the last half century, by placing them within conceptual, explanatory, and historical contexts. First, literature relevant to the primary concepts of "class" and "status", is reviewed. Second, four institutions whose influence is fundamental in shaping these patterns are identified to form an explanatory context: family, polity, economy, and education.

Proximal femoral medullary canal diameters in Indians: correlation between anatomic, radiographic, and computed tomographic measurements.

Purpose: To compare anatomic, radiographic, and computed tomographic (CT) measurements of the proximal femur in an Indian population.

Methods: 26 left and 24 right dried cadaveric femurs were obtained. Each femur was divided into segments at 10 cross-sectional levels from proximal to distal.

Immunohistochemical analysis of ageing and osteoarthritic articular cartilage.

Articular cartilage degeneration seen in osteoarthritis is primarily the consequence of events within the articular cartilage that leads to the production of proteases by chondrocytes. 22 osteoarthritic cartilage specimens were obtained from patients with primary osteoarthritis (46-81 years) undergoing total knee replacement. 12 age-matched (41-86 years) and 16 young (16-40 years) non-osteoarthritic control cartilage specimens were obtained from the cadavers in the department of Anatomy and from patients undergoing lower limb amputation in Trauma center of PGIMER, Chandigarh.

Tramadol added to bupivacaine does not prolong analgesia of continuous psoas compartment block.

The primary aim of our study was to evaluate the quality and duration of analgesia when tramadol was added to 0.25% bupivacaine for continuous psoas compartment block (CPCB) using visual analog pain scores. Thirty patients were prospectively randomized into two equal groups (n = 15).

Combined continuous "3-in-1" and sciatic nerve blocks provide improved postoperative analgesia with no correlation to catheter tip location after unilateral total knee arthroplasty.

This study assessed the efficacy and duration of postoperative analgesia after continuous sciatic nerve block with and without continuous "3-in-1" block with bupivacaine after unilateral total knee arthroplasty and determined catheter tip correlation with analgesia. Thirty patients were randomized into 2 groups. Results suggested significantly reduced pain and rescue analgesic requirement in combined sciatic and 3-in-1 (group TS) compared to 3-in-1 group alone (group T).

High resolution sonography for analysis of meniscal injuries.

High resolution ultrasonography was done prospectively in 51 adult patients with clinically suspected meniscal injuries to evaluate the sensitivity and specificity of ultrasonography as a primary diagnostic tool and to see if it was possible to evaluate the site, extent and size of the tear. All cases were confirmed arthroscopically; ultrasonographic examination revealed inhomogenecity in 45 cases and this was accurate in 40 cases; in 3 cases ultrasonography gave a false positive result and in 2 cases the wrong meniscus was shown to be torn. The six cases with no findings on ultrasonography were proven to have no meniscal tear.

Periprosthetic femoral fractures around well fixed implants: a simple method of fixation using LC-DCP with trochanteric purchase.

Periprosthetic fractures of the femur are among the most serious complications in hip surgery. Various classifications have been suggested. At present the Vancouver classification system probably comes closest to the ideal.

Combined lateral closing and medial opening-wedge high tibial osteotomy.

Background: Long-term studies have indicated that the clinical success of high tibial osteotomy deteriorates with time. The purpose of this study was to evaluate the long-term results of a combined lateral closing and medial opening-wedge technique for high tibial osteotomy with a minimum follow-up of fifteen years.

Methods: From January 1981 to June 1990, ninety-two patients (ninety-four knees) had a high tibial valgus osteotomy.

Osteoarthritic femoral articular cartilage of knee joint in man.

Osteoarthritis is the most common of the various articular disorders affecting man. The present study was conducted to observe the microstructure of osteoarthritic human femoral articular cartilage by light microscopy. Fifteen osteoarthritic cartilage specimens obtained from patients with primary osteoarthritis (52-80 years) undergoing total knee replacement were processed for paraffin sections.

The effect of local administration of phenytoin on fracture healing: an experimental study.

The antiepileptic drug phenytoin (Diphenylhydantoin) has been documented to have a beneficial effect on wound healing; its effect on fracture healing, however is still unclear. In an attempt to evaluate any potential benefits phenytoin may have on fracture healing, a prospective study was undertaken combining histology, histomorphometry and radiology, in which the effects of locally administered phenytoin were analysed. Twenty-four Wistar strain rats of 8-9 months age were assigned into two groups of 12 each (matched for age, sex and weight).

Hybrid external fixation in periarticular tibial fractures. Good final outcome in 56 patients.

Out of 65 patients with periarticular fractures of the tibia treated by use of hybrid external fixation (a combination of indigenously manufactured version of ring and AO tubular fixator) from February 1997 to October 2003, 56 cases were taken up for this study with a minimum follow-up of 12 months. The injury was due to a high-velocity motor vehicle accident in 49 and a fall in 7 patients. Thirty five were tibial plateau fractures and 21 were distal tibial plafond fractures.

A missed injury in multiple trauma patient-is it avoidable?

We report a case of a 24-year-old male with fractures at multiple levels of both femur and tibia. The patient was operated upon and a satisfactory clinical outcome was achieved. In spite of a thorough secondary survey, a displaced ankle fracture had been missed.

The uncemented isoelastic/isotitan total hip arthroplasty. A 10-15 years follow-up with bone mineral density evaluation.

The present study analyses the long-term outcome of isoelastic hip prostheses and their influence on the extent of periprosthetic bone remodeling. Ninety-two patients (102 hips) with Isoelastic/Isotitan uncemented total hip arthroplasty were evaluated after an average of 13.4 years.

Comminuted refracture of the distal femur and condyles in patients with an intramedullary nail: a report of 5 cases.

Patients with in situ intramedullary nails sustaining a second distal femoral fracture following high-velocity trauma are infrequently reported in the literature. We report 5 such patients who sustained a second injury after 6 to 24 months, resulting in another fracture at the nail-tip level. These second fractures severely comminuted the femoral condyles.

Revascularization of diaphyseal bone segments by vascular bundle implantation.

Vascularized bone transfer is an effective, established treatment for avascular necrosis and atrophic or infected nonunions. However, limited donor sites and technical difficulty limit its application. Vascular bundle transplantation may provide an alternative.

Bupivacaine/ketamine is superior to intra-articular ketamine analgesia following arthroscopic knee surgery.

Purpose: Centroneuraxial and parenteral administration of ketamine has been shown to produce analgesia. However, this analgesia is limited by adverse effects. The purpose of this study was to determine whether ketamine alone or in combination with bupivacaine provides superior pain relief after surgery in patients undergoing knee arthroscopy.

Extra articular arthroscopic release in post-traumatic stiff knees: a prospective study of endoscopic quadriceps and patellar release.

Knee stiffness due to mismanaged trauma is still common in underdeveloped countries. Many patients with distal femoral fractures, patellar injuries or other local trauma present with intra-articular and extra-articular adhesions between the quadriceps and anterior femur. Nineteen knees with post trauma stiffness due to combined intra- and extra- articular aetiology were taken up for arthroscopic aided release after failing an aggressive physiotherapy protocol.

Technetium-99m ciprofloxacin imaging in the diagnosis of postsurgical bony infection and evaluation of the response to antibiotic therapy: A case report.

The use of radiolabelled antibiotics is fast emerging as a promising diagnostic test for the detection of infective lesions, because of their specific binding to the bacterial component. Ciprofloxacin is a broad-spectrum antibiotic that has been used as a radiolabelled antibiotic in both the diagnosis of infections in rabbits and in clinical trials on humans. The diagnosis of skeletal microbial infections remains a challenge, especially in orthopaedic patients with implants.

Open reduction and internal fixation of volar Barton's fractures: a prospective study.

Purpose: To assess the functional and clinical outcomes of open reduction with internal fixation in the treatment of Barton's fracture of the wrist.

Methods: From January 1997 to July 2003, a total of 19 cases of volar Barton's fracture were operated on by open reduction and internal fixation at the Nehru Hospital, Chandigarh, India. Records of 16 cases were available for study.