Functional and Radiological Outcomes of Surgically Treated Coxa-vara in Children

BACKGROUND

Coxa vara is a condition in which the neck-shaft angle of the femur decreases below its normal value (<110 degrees) based on age. The deformity can be primarily caused by a congenital defect of the femoral neck cartilage or by secondary causes related to skeletal dysplasia, trauma, infection, and pathological bone disorders. The surgical treatment aims to restore the normal anatomy, thereby improving the mechanics and function of the hip joint. Generally, the HE angles should be corrected to <35 to 40 degrees, converting the shear forces into compressive forces. Our study aims to report the surgical outcome of coxa vara with various pathologies using radiographic measurement and functional scoring.

METHODS

Thirty-eight hips in 28 patients who underwent surgery for treatment of coxa-vara from 2013 to 2022 were included. Radiographic parameters like Hilgenreiner-epiphyseal angle and neck-shaft angle were assessed preoperatively and at the latest follow-up. Harris hip score was used for functional outcome.

RESULTS

The mean age was 11.13 (5 to 18). The average follow-up was 48 (ranging from 24 to 96) months. The mean preoperative neck-shaft angle was 82 degrees, and the Hilgenreiner-epiphyseal angle was 71 degrees. At the latest follow-up, the mean neck-shaft angle was 127 degrees, and the Hilgenreiner-epiphyseal angle was 33 (P<0.001). The Harris hip score improved from 63 preoperatively to 92 at the latest follow-up (P<0.001). There was no recurrence of deformities at the mean follow-up of 37.87 months. Four complications occurred with k-wire fixation in whom revalgus osteotomy was done.

CONCLUSIONS

Surgical correction of coxa vara in various pathologies can be done successfully with the Hilgenreiner-epiphyseal angle corrected to ≤ 35 degrees or the neck shaft angle corrected to >110 degrees to prevent deformity recurrence. The majority of the patients reported improvement in hip function. However, a longer-term follow-up is required to determine further outcomes regarding the recurrence of the deformity.

Effect of Infrapatellar Fat Pad Preservation vs Resection on Clinical Outcomes After Total Knee Arthroplasty in Patient with End-Stage Osteoarthritis

Purpose

The management of infrapatellar fat pad (IPFP) during total knee arthroplasty (TKA) is the subject of ongoing debate. There is conflicting evidence whether IPFP should be preserved or resected during TKA to improve clinical outcomes. This study sought to establish if there is a benefit of one over another in terms of clinical function & patient satisfaction.

Material & Methods

Total of 67 patients (96 knees), 11 males & 56 females with a mean age of 66.29 years, who underwent TKA between 2016 and 2020 were included in the study. The planning for IPFP preservation (IPFP-P) on right side (50 knees) & IPFP resection (IPFP-R) on left side (46 knees) was done prospectively. We prospectively evaluated clinical outcomes post-TKA, comparing the right knee to the left knee in terms of IPFP-P vs IPFP-R using the oxford knee scoring (OKS) system. The SF-12 was used to evaluate and compare patient satisfaction between the two groups.

Results

The mean OKS in the IPFP-P group was 42.86 ± 2.63 & in the IPFP-R group was 44.22 ± 2.40. The OKS differed significantly between the two groups (p < 0.05). Patient with IPFP-R group had significantly better OKS. The mean Sf-12 (physical & mental component) in the IPFP-P was 51.05 ± 4.15 & 59.29 ± 2.53 & in IPFP-R was 51.23 ± 4.74 & 59.24 ± 2.78, showing no significant differences.

Conclusion

Our study shows that IPFP-R gave marginally better patient-reported functional outcome scores (OKS), but there was no difference in patient satisfaction (SF-12 scores) between the two groups.

Hip arthrodesis in children : a review of 26 cases with a mean of 20 years' follow-up

AIMS

To examine the long-term outcome of arthrodesis of the hip undertaken in a paediatric population in treating painful arthritis of the hip. In our patient population, most of whom live rurally in hilly terrain and have limited healthcare access and resources, hip arthrodesis has been an important surgical option for the monoarticular painful hip in a child.

METHODS

A follow-up investigation was undertaken on a cohort of 28 children previously reported at a mean of 4.8 years. The present study looked at 26 patients who had an arthrodesis of the hip as a child at a mean follow-up of 20 years (15 to 29).

RESULTS

The mean Harris Hip Score (HHS) increased from 39.60 (SD 11.06) preoperatively to 81.02 (SD 8.86; p = 0.041) at final review. At latest follow-up, the HHS was found to be excellent in four patients (15%), good in 11 (42%), and fair in 11 (42%). A total of 16 patients (62%) reported mild low back pain, five (19%) had moderate pain, and five (19%) patients had no back pain. Mild ipsilateral knee pain was reported by 19 (73%), moderate pain by one (4%), and no pain by six (23%) patients. Mild contralateral hip pain was reported by ten patients (38%), and no pain by 16 (62%). The 36-Item Short Form Health Survey scores were very good in four patients (15%), good in 18 (70%), and poor in four (15%), with a mean score of 70.92 (SD 12.65). Of 13 female patients who had given birth, 12 did so with uncomplicated vaginal delivery. All patients had to modify their posture for toileting, putting on lower body clothes, foot care, and putting on shoes.

CONCLUSION

Our results show that with hip arthrodesis, most patients have relatively good function at long-term follow-up, although some pain is experienced in adjacent joints, and modification in some activities of daily living is common.Cite this article: Bone Joint J 2022;104-B(9):1089-1094.

The effects of different activating agents on the physical and electrochemical properties of activated carbon electrodes fabricated from wood-dust of Shorea robusta

This study focuses on the effects of activating agents on the physical and electrochemical properties of activated carbon (AC) electrodes, fabricated from wood dust of Shorea robusta. Three different activating agents namely H₃PO_4, KOH and Na₂CO₃ have been used to prepare ACs, which were named as: Sr–H₃PO₄, Sr–KOH and Sr–Na₂CO₃. The ACs were characterized by TGA/DSC, XRD, Raman, SEM, FTIR and BET. All the as prepared ACs were found to be amorphous in nature. The oxygen surface functionality was developed at the surface. The surface area of Sr–H₃PO₄, Sr–KOH and Sr–Na₂CO₃ were found to be 1269.5 m²/g, 280.6 m²/g and 58.9 m²/g respectively. The activated carbon-electrodes were then fabricated and supercapacitive performances were evaluated by “three electrode system” in aqueous 6M KOH using cyclic voltammetry (CV), galvanostatic charge discharge (GCD) and electrochemical impedance spectroscopy (EIS).The GCD performed at 1A/g revealed the specific capacitance values were 136.3 F/g, 42.2 F/g and 59.1 F/g for Sr–H₃PO₄, Sr–KOH and Sr–Na₂CO₃-electrodes, respectively. Energy density for Sr–H₃PO₄ electrode was found to be 3.0 Wh/kg at 99.6 W/kg power densities. Moreover, it also displayed imposing cyclic stability of about 96.9 %, 89.5 % and 78.5 % after 1000 cycles of charge/discharge respectively. The overall electrochemical performance of Sr–H₃PO₄ showed outstanding supercapacitive performances demonstrating the high possibility of this material to be used for the EDLC application in supercapacitive energy storage. The Nyquist plot also showed the lowest internal resistance of about 0.4 Ω for Sr–H₃PO₄ electrode.

Three-Port versus Four-Port Laparoscopic Cholecystectomy: A Randomized Controlled Trial

 Laparoscopic cholecystectomy (LC) is one of the most common surgery performed and is traditionally performed using four ports. With the aim of improving patient’s comfort, port numbers have been reduced to single port. But feasibility and the extra expense that comes with single and double port LC has made them less attractive. Three port LC can be a safe alternative to four port LC, and various research has shown its safety. This study compares the three port LC with the traditional four port LC with the objective of assessing feasibility and benefit of the decreased port number. We evaluated 217 patients who were randomly allocated for three port and four port LC. Both the groups were compared for operative time, assessment of postoperative pain, days of hospital stay and postoperative recovery time after discharge. The parameters were compared using Statistical Package for the Social Sciences (SPSS) version 16. Among 217 patients, 123 underwent three port LC and 94 underwent four port LC. The larger number were females (79.7%), and with comparable age group of patients. Rate of conversion to open cholecystectomy, postoperative pain scale, analgesic requirement, average hospital stay and port site infection rates were comparable in both groups of patients. The average time taken for operation was less in three port LC than the four port LC but this was not statistically significant. There is no significant difference between 3 port and 4 port LC in terms of time required for the surgery, conversion rate, complication and duration of hospital stay.

Anticipated Pain and Pain Experience Among Orthodontic Patients: Is there any Difference?

Background Orthodontic treatment is taken as a painful procedure by most of the patients. The pain can be experienced during different procedures like separator placement, banding, bonding, extraction as well as arch wire activation and debonding. There are very few studies done on the anticipated pain and pain experienced among mentioned orthodontic procedures. Objectives To compare the anticipated pain and pain experience among the patients going for comprehensive orthodontic treatment. Methods Total 45 patients going for comprehensive orthodontic therapy are enrolled into the study. They are given a 100mm Visual Analogue Scale (VAS) for pain. The anticipated pain as well as perceived pain after different orthodontic procedures are recorded on the VAS by patients and returned back to orthodontic office. The data are analyzed by SPSS 16.00 software by paired and independent t-test for the statistical significance. Results The result showed that there is significant difference between the anticipated pain before orthodontic treatment and the pain experienced following orthodontic treatment. It also showed that perception of pain between two sexes is significantly different. The comparison of anticipated pain among male and female does not show any significant difference, however the pain felt after separator placement as well as after orthodontic bonding is significantly different in two sexes. Conclusion The level of anticipated pain before orthodontic treatment is higher than the real pain experienced after orthodontic procedures. So it is better to counsel and explain the patients about the orthodontic treatment and procedures. Kathmandu University Medical Journal | Vol.10 | No. 2 | Issue 38 | Apr – June 2012 | Page 71-73 DOI: http://dx.doi.org/10.3126/kumj.v10i2.7348

Rett Syndrome: A Case report

Rett syndrome (RS) is a severe neuro-developmental disorder leading to severe intellectual disability in females all around the world. A four-year-old girl from Kathmandu presented with classic features of Rett syndrome (RS), including developmental regression with dementia, loss of acquired speech and hand function, and stereotypic hand movements along with generalized tonic clonic convulsion. Key words: Rett Syndrome, Developmental Regression   DOI = 10.3126/jnps.v28i1.1401   J. Nepal Paediatr. Soc. Vol.28(1) p.17-19

Characterization and Applications of Silver Sulphide Based Membrane Electrodes

The polycrystalline materials obtained by co-precipitation of silver sulphide and appropriate silver halide are used to prepare silver sulphide based membrane electrodes selective to the silver, chloride, bromide, iodide, and sulphide ions. The powder materials are characterized by x-ray diffraction, SEM equipped with EDAX. These membrane electrodes are found to give Nernstian response with the appropriate ions in the concentration range from 1x10-1 to 1x10-5 M. The performance of these home made electrodes is at par with the commercial electrodes. The electrodes have been successfully used for the quantitative determination of chloride, bromide iodide, silver, and sulphide ions and also for the determination of thiamine in pharmaceutical preparations. For developing countries like Nepal, who can not afford to procure high cost commercial ion selective electrodes, these home made ion selective electrodes are especially appealing since the electrode can be fabricated with ease in low cost and the electrode is well behaved and sufficiently accurate for the analysis with ion selective electrodes. Key words: Ion selective electrode; Home made ion selective electrode; Silver sulphide; Thiamine; Vitamin B1. DOI: 10.3126/sw.v7i7.3818 Scientific World Vol.7(7) 2009 pp.19-23